Extrahepatic Pseudoaneurysms and Ruptures of the Hepatic Artery in Liver Transplant Recipients: Endovascular Management and a New Iatrogenic Etiology

Journal Article · Fri Feb 15 04:00:00 EST 2013 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-012-0408-Y· OSTI ID:22156503

Saad, Wael E. A.,; Dasgupta, Niloy; Lippert, Allison J.; Turba, Ulku C.; Davies, Mark G. ^[1]; Kumer, Sean ^[2]; Gardenier, Jason C.; Sabri, Saher S.; Park, Auh-Whan ^[1]; Waldman, David L. ^[3]; Schmitt, Timothy ^[2]; Matsumoto, Alan H.; Angle, John F. ^[1]

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1. University of Virginia Health System, Division of Vascular Interventional Radiology, Department of Radiology (United States)
2. University of Virginia Health System, Division of Solid Organ Transplantation, Department of Surgery (United States)
3. University of Rochester Medical Center, Department of Imaging Sciences (United States)

To characterize extrahepatic pseudoaneurysm regarding incidence and etiology and determine the effectiveness of endovascular management. A retrospective audit of 1,857 liver transplants in two institutions was performed (1996-2009). Recipients' demographics, clinical presentation, transplant type, biliary anastomosis, and presence of biliary endoprostheses were noted. Pseudoaneurysms were classified into iatrogenic (associated with biliary endoprosthesis or angioplasty) or spontaneous extrahepatic pseudoaneurysms. Spontaneous and iatrogenic pseudoaneurysms were compared for time from transplant, presenting symptoms, location in the arterial anatomy, and 3-month graft survival. Arterial patency and 6-month graft survival were calculated. Twenty pseudoaneurysms were found (1.1 %, 20/1,857): 9 (0.5 % of transplants, 9/1,857) were spontaneous and 11 (0.6 % of transplants, 11/1,857) were 'iatrogenic' (due to minimally invasive procedures: 4 angioplasty and 7 biliary endoprostheses). Sixty percent (12/20) underwent endovascular management (4 coil embolization and 8 stent-grafts). Technical success was 83 % (10/12) with a mean arterial patency of 70 % (follow-up mean, 4.9; range, 0-18 months). The 1-, 3-, and 6-month graft survival was 70, 40, and 35 %, respectively. Due to minimally invasive procedures, posttransplant extrahepatic pseudoaneurysms are no longer an exclusive complication of the transplant surgery itself. Endovascular management is effective to stabilize patients but has not improved historic postsurgical graft survival.

• OSTI ID: 22156503
• Journal Information: Cardiovascular and Interventional Radiology, Journal Name: Cardiovascular and Interventional Radiology Journal Issue: 1 Vol. 36; ISSN 0174-1551; ISSN CAIRDG
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ANATOMY
ARTERIES
AUDITS
ETIOLOGY
GRAFTS
LIVER
PATIENTS
RUPTURES
SURGERY
SYMPTOMS