Extrahepatic pseudoaneurysms and ruptures of the hepatic artery in liver transplant recipients: endovascular management and a new iatrogenic etiology.
OBJECTIVE
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.
Division of Vascular Interventional Radiology, Department of Radiology, University of Virginia Health System, 1215 Lee Street, PO Box 800170, Charlottesville, VA 22908, USA. wspikes@yahoo.com
Wael E A
WE
Saad
Niloy
N
Dasgupta
Allison J
AJ
Lippert
Ulku C
UC
Turba
Mark G
MG
Davies
Sean
S
Kumer
Jason C
JC
Gardenier
Saher S
SS
Sabri
Auh-Whan
AW
Park
David L
DL
Waldman
Timothy
T
Schmitt
Alan H
AH
Matsumoto
John F
JF
Angle
D000328:Adult; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D015331:Cohort Studies; D016001:Confidence Intervals; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006499:Hepatic Artery; D006801:Humans; D007049:Iatrogenic Disease; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome