Extrahepatic pseudoaneurysms and ruptures of the hepatic artery in liver transplant recipients: Endovascular management and a new iatrogenic etiology

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

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

Purpose: To characterize extrahepatic pseudoaneurysm regarding incidence and etiology and determine the effectiveness of endovascular management. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)118-127
Number of pages10
JournalCardiovascular and Interventional Radiology
Volume36
Issue number1
DOIs
StatePublished - Feb 1 2013
Externally publishedYes

Keywords

  • Complication
  • Liver/hepatic
  • Pseudoaneurysm
  • Transplant

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Saad, W. E. A., Dasgupta, N., Lippert, A. J., Turba, U. C., Davies, M. G., Kumer, S., Gardenier, J. C., Sabri, S. S., Park, A. W., Waldman, D. L., Schmitt, T., Matsumoto, A. H., & Angle, J. F. (2013). Extrahepatic pseudoaneurysms and ruptures of the hepatic artery in liver transplant recipients: Endovascular management and a new iatrogenic etiology. Cardiovascular and Interventional Radiology, 36(1), 118-127. https://doi.org/10.1007/s00270-012-0408-y