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Extrahepatic Pseudoaneurysms and Ruptures of the Hepatic Artery in Liver Transplant Recipients: Endovascular Management and a New Iatrogenic Etiology
- Source :
- CardioVascular and Interventional Radiology. 36:118-127
- Publication Year :
- 2012
- Publisher :
- Springer Science and Business Media LLC, 2012.
-
Abstract
- To characterize extrahepatic pseudoaneurysm regarding incidence and etiology and determine the effectiveness of endovascular management. 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. 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. 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.
- Subjects :
- Adult
Graft Rejection
Male
medicine.medical_specialty
medicine.medical_treatment
Iatrogenic Disease
Kaplan-Meier Estimate
Aneurysm, Ruptured
Risk Assessment
Cohort Studies
Pseudoaneurysm
Hepatic Artery
Transplant surgery
Angioplasty
Confidence Intervals
medicine
Humans
Radiology, Nuclear Medicine and imaging
cardiovascular diseases
Retrospective Studies
Transplant type
business.industry
Incidence (epidemiology)
Endovascular Procedures
Graft Survival
Middle Aged
medicine.disease
Liver Transplantation
Surgery
Radiography
Survival Rate
Treatment Outcome
surgical procedures, operative
medicine.anatomical_structure
cardiovascular system
Etiology
Female
Radiology
Cardiology and Cardiovascular Medicine
Complication
business
Aneurysm, False
Follow-Up Studies
Artery
Subjects
Details
- ISSN :
- 1432086X and 01741551
- Volume :
- 36
- Database :
- OpenAIRE
- Journal :
- CardioVascular and Interventional Radiology
- Accession number :
- edsair.doi.dedup.....d7e8037b6502b3497817cf710c00c278