title: Endovascular treatment of active bleeding after liver transplant.
abstract: 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.
authors.affiliation: Department of Radiology, Baskent University Faculty of Medicine, Ankara, Turkey. aliharman@baskent-ank.edu.tr
authors.forename: Ali
authors.initials: A
authors.lastname: Harman
authors.forename: Fatih
authors.initials: F
authors.lastname: Boyvat
authors.forename: Baris
authors.initials: B
authors.lastname: Hasdogan
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Aytekin
authors.forename: Hamdi
authors.initials: H
authors.lastname: Karakayali
authors.forename: Mehmet
authors.initials: M
authors.lastname: Haberal
mesh_terms: 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