title: Combined surgical and interventional radiologic management strategies in patients with arterial pseudo-aneurysms after multivisceral transplantation.
abstract: BACKGROUND
  Multivisceral transplantation has recently evolved to be a life-saving procedure for patients with intestinal failure and complex abdominal pathology. A composite aortic graft is always needed to restore the arterial flow to the transplanted organs. Accordingly, arterial complications can be life-threatening requiring prompt intervention. Herein, we describe innovative technical approaches in seven recipients who developed pseudo-aneurysm (PA) after transplantation.
  
  
  METHODS
  With a total of 285 composite visceral transplants, 15 (5.2%) patients experienced vascular complications. Of these, 7 were life-threatening PAs that were diagnosed 61 to 2677 days after transplantation. Due to the anatomic and technical complexity of the allograft vasculature, endovascular techniques were introduced alone (n=2) or in conjunction with surgical intervention (n=5) in an attempt to rescue patients and salvage the transplanted organs.
  
  
  RESULTS
  The endovascular and surgical technical approaches used for each of the 7 PA actively bleeding patients was successful in 5 (71%). Of these, 2 (40%) are alive 86 to 117 months after the intervention. The remaining 5 recipients died of recurrent hemorrhage (n=2), liver failure (n=1), and pneumonia (n=1). The cause of death was unknown in the remaining patient. Retransplantation and intra-abdominal infections were major risk factors. Candida was the most common isolated microorganism.
  
  
  CONCLUSIONS
  Recipients of composite visceral allografts are at risk of developing life-threatening PAs, particularly in those with early posttransplantation abdominal infections. Prompt multidisciplinary diagnosis and therapeutic approaches are crucial management strategies.
authors.affiliation: 1 Department of Radiology, University of Pittsburgh Medical Center Health System, Pittsburgh, PA. 2 Department of Transplant Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, PA. 3 Department of Surgery/Transplant, Cleveland Clinic Foundation, Cleveland, OH. 4 Address correspondence to: Nikhil B. Amesur, M.D., Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop Street, PST 4886, Pittsburgh, PA.
authors.forename: Nikhil B
authors.initials: NB
authors.lastname: Amesur
authors.forename: Albert B
authors.initials: AB
authors.lastname: Zajko
authors.forename: Guilherme
authors.initials: G
authors.lastname: Costa
authors.forename: Kareem M
authors.initials: KM
authors.lastname: Abu-Elmagd
mesh_terms: D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D015641:Radiography, Interventional; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous; D014781:Viscera / Q000637:transplantation*