title: Percutaneous management of a hepatic artery aneurysm: bleeding after liver transplantation.
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 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.
authors.affiliation: Department of Gastroenterology and Hepatology, University of Innsbruck, Austria.
authors.forename: Gunda
authors.initials: G
authors.lastname: Millonig
authors.forename: Ivo W
authors.initials: IW
authors.lastname: Graziadei
authors.forename: Peter
authors.initials: P
authors.lastname: Waldenberger
authors.forename: Alfred
authors.initials: A
authors.lastname: Koenigsrainer
authors.forename: Werner
authors.initials: W
authors.lastname: Jaschke
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Vogel
mesh_terms: D000328:Adult; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D019917:Blood Vessel Prosthesis Implantation; D002758:Cholangiography; D004621:Embolization, Therapeutic; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D012086:Reoperation; D015607:Stents; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed