Percutaneous management of a hepatic artery aneurysm: bleeding after liver transplantation

Cardiovascular and Interventional Radiology
Gunda MillonigWolfgang Vogel

Abstract

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 embolizati...Continue Reading

Citations

Sep 1, 2005·Cardiovascular and Interventional Radiology·Gurpreet S GulatiSubrat Acharya
Dec 29, 2011·Cardiovascular and Interventional Radiology·Ahmed M ElsharkawyDerek M Manas
Jul 7, 2012·Clinics and Research in Hepatology and Gastroenterology·Ning-Ning LuRen-You Zhai
Nov 14, 2006·Transplantation Proceedings·J FistourisS Friman
Jun 14, 2005·Transplant International : Official Journal of the European Society for Organ Transplantation·Gian Luigi AdaniFabrizio Bresadola
Jun 15, 2007·Transplant International : Official Journal of the European Society for Organ Transplantation·Timm DeneckeEnrique Lopez Hänninen
Feb 13, 2013·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·E BoleslawskiF R Pruvot
Nov 13, 2010·Transplant International : Official Journal of the European Society for Organ Transplantation·Hsin-You OuYu-Fan Cheng
Nov 1, 2013·Minimally Invasive Therapy & Allied Technologies : MITAT : Official Journal of the Society for Minimally Invasive Therapy·Rie Yagi YoshidaNoboru Tanigawa
Mar 16, 2006·The Journal of Medical Investigation : JMI·Bayindir CimsitAli Sami Emre
Nov 10, 2011·Acta Radiologica·Aslihan Semiz-OysuWojciech Cwikiel

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