Endovascular treatment of active bleeding after liver transplant.
OBJECTIVE
To evaluate the incidence of active bleeding complications following transplant and the efficacy of interventional radiologic management.


METHODS
Between June 2000 and February 2007, 14 liver transplant patients with active bleeding were treated via endovascular techniques (coils, glue, or graft-covered stents). Active bleeding was spontaneous in 6 patients through the inferior epigastric artery (n=1), the inferior phrenic artery (n=1), the superior mesenteric artery (n=2), the internal mammary artery (n=1), and the hepatic artery (n=1). In 8 patients, active bleeding was due to transhepatic biliary or endovascular interventions. Hemobilia (n=2) due to pseudoaneurysm formation after transhepatic biliary interventions was embolized with coils. Hepatic artery rupture was observed in 6 patients during endovascular interventions performed on hepatic artery stenosis or thrombosis that had been treated with graft-covered stents. Technical success, clinical improvement, and complications were documented.


RESULTS
Active bleeding was stopped by endovascular intervention in 13 of 14 patients. Embolizations with coils or glue were successful. In 1 patient with hepatic artery bleeding, the graft-covered stent failed to seal the rupture site, and this patient underwent reoperation.


CONCLUSIONS
Arterial bleeding complications after liver transplant during the early and late postoperative period, due either to spontaneous active bleeding or to percutaneous or endovascular interventions, can be successfully managed with interventional radiologic techniques.
Harman
Ali
A
Department of Radiology, Baskent University Faculty of Medicine, Ankara, Turkey. aliharman@baskent-ank.edu.tr
Boyvat
Fatih
F
Hasdogan
Baris
B
Aytekin
Cuneyt
C
Karakayali
Hamdi
H
Haberal
Mehmet
M
D000293:Adolescent; D000328:Adult; D000792:Angiography; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D019233:Retreatment; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome