Percutaneous Management of a Hepatic Artery Aneurysm: Bleeding After Liver Transplantation

Journal Article · Wed Sep 15 04:00:00 EDT 2004 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-004-0170-X· OSTI ID:21088220

Millonig, Gunda; Waldenberger, Peter ^[1]; Koenigsrainer, Alfred ^[2]; Jaschke, Werner ^[1]; Vogel, Wolfgang ^[3]

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1. University of Innsbruck, Department of Radiology I (Austria)
2. University of Innsbruck, Transplant Surgery (Austria)
3. University of Innsbruck, Department of Gastroenterology and Hepatology (Austria)

In this article we present an unusual case of hepatic artery aneurysm bleeding due to a hepatic artery thrombosis after liver transplantation. The patient developed a recurrent hepatic artery thrombosis leading to severe graft failure in four consecutive liver transplantations. While being evaluated for a fifth transplant, stabilization of the clinical situation was attempted by interventional therapy. The first intervention was to place a stent into the hepatic artery to prevent further ischemic damage. This failed to improve graft function, but unfortunately led to the development of a pseudoaneurysm at the distal end with a subsequent rupture into the biliary tree. Bleeding was treated successfully by direct puncture and coil embolization of the aneurysm. In addition, the patient demonstrated a hemodynamically relevant portal vein stenosis on the CT scan. Stenting of the portal vein markedly improved graft function. After extensive investigations, a paroxysmal nocturnal hemoglobinuria was found to be the underlying cause of the recurrent hepatic artery thrombosis. Here we suggest that hepatic artery aneurysm bleeding is a rare but potentially fatal complication that can be successfully treated by percutaneous coil embolization. Additionally, we propose that stenting of the portal vein can lead to a significant improvement of the graft perfusion even though the hepatic artery remained occluded.

• OSTI ID: 21088220
• Journal Information: Cardiovascular and Interventional Radiology, Journal Name: Cardiovascular and Interventional Radiology Journal Issue: 5 Vol. 27; ISSN 0174-1551; ISSN CAIRDG
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ARTERIES
COMPUTERIZED TOMOGRAPHY
GRAFTS
LIVER
PATIENTS
RUPTURES
THROMBOSIS
VEINS