title: Preservation of the arterial vascularisation after hepatic artery pseudoaneurysm following orthotopic liver transplantation: long-term results.
abstract: BACKGROUND
  Hepatic artery pseudoaneurysm (HAP) is a serious complication of orthotopic liver transplantation (OLT). The aim of this study was to determine risk factors for HAP and the best management of this complication.
  
  
  METHODS
  Between 1990 and 2005, 787 OLT were performed at our center. Patients who developed HAP were identified from our prospective database and risk factors of HAP were identified. Management of HAP was analyzed retrospectively.
  
  
  RESULTS
  There were 16 OLT (2.5%) complicated by HAP [median delay =13 days; range: 4-100 days]. Presentation was massive bleeding with shock (n=13), pain (n=2), or transient gastrointestinal bleeding (n=1). Bacteriological culture of HAP wall or ascites fluid was positive in 13 (81%) patients. Bilio-enteric anastomosis and biliary leak were identified as risk factors for HAP (p=0.011 and 0.002, respectively), whereas indication for OLT, surgical technique (full-graft OLT versus other techniques), and re-LT were not. Mortality rate after HAP rupture was 53% (7/13), but no deaths occurred in the 3 patients treated before rupture. Treatment included: excision and immediate revascularization [n=7; early mortality =2 (28%), long-term graft survival =4 (57%)], hepatic artery ligation [n=5; early mortality =3 (80%);, long-term graft survival with good liver function =0], and endovascular treatment [n=2; early mortality =0, long-term survival with good liver function =2].
  
  
  CONCLUSIONS
  HAP post-OLT carries a high mortality rate when detected after rupture, but recognition before rupture usually allows a successful outcome. Reconstruction with bilio-enteric anastomosis and postoperative biliary leak increase the risk for HAP. In these settings, CT with contrast injection should be performed to screen for HAP when there is any suspicion. Graft revascularization should be attempted whenever possible.
authors.affiliation: Department of General, Visceral and Digestive Surgery, Centre Hospitalier de Fontenoy, Le Mans, France.
authors.forename: Enrico
authors.initials: E
authors.lastname: Volpin
authors.affiliation: Department of Hepato-biliary Surgery and Liver Transplantation, Assistance Publique des Hôpitaux de Paris, Clichy, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Pessaux
authors.affiliation: Department of Hepato-biliary Surgery and Liver Transplantation, Assistance Publique des Hôpitaux de Paris, Clichy, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Sauvanet
authors.affiliation: Department of Radiology, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France.
authors.forename: Annie
authors.initials: A
authors.lastname: Sibert
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France.
authors.forename: Reza
authors.initials: R
authors.lastname: Kianmanesh
authors.affiliation: Department of Hepatology, Liver Intensive Care Unit and Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France.
authors.forename: François
authors.initials: F
authors.lastname: Durand
authors.affiliation: Department of Hepato-biliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France.
authors.forename: Daniele
authors.initials: D
authors.lastname: Sommacale
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000209:etiology* / Q000382:microbiology / Q000401:mortality*; D000785:Aneurysm, Infected / Q000209:etiology* / Q000382:microbiology / Q000401:mortality*; D017542:Aneurysm, Ruptured / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D006085:Graft Survival; D006499:Hepatic Artery / Q000382:microbiology; D006801:Humans; D015994:Incidence; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D055815:Young Adult