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CardioVascular and Interventional Radiology

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01-02-2013 | Clinical Investigation

Extrahepatic Pseudoaneurysms and Ruptures of the Hepatic Artery in Liver Transplant Recipients: Endovascular Management and a New Iatrogenic Etiology

Authors: Wael E. A. Saad, Niloy Dasgupta, Allison J. Lippert, Ulku C. Turba, Mark G. Davies, Sean Kumer, Jason C. Gardenier, Saher S. Sabri, Auh-Whan Park, David L. Waldman, Timothy Schmitt, Alan H. Matsumoto, John F. Angle

Published in: CardioVascular and Interventional Radiology | Issue 1/2013

Abstract

Purpose

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.

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Title: Extrahepatic Pseudoaneurysms and Ruptures of the Hepatic Artery in Liver Transplant Recipients: Endovascular Management and a New Iatrogenic Etiology
Authors: Wael E. A. Saad
Niloy Dasgupta
Allison J. Lippert
Ulku C. Turba
Mark G. Davies
Sean Kumer
Jason C. Gardenier
Saher S. Sabri
Auh-Whan Park
David L. Waldman
Timothy Schmitt
Alan H. Matsumoto
John F. Angle
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 1/2013
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-012-0408-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Extrahepatic Pseudoaneurysms and Ruptures of the Hepatic Artery in Liver Transplant Recipients: Endovascular Management and a New Iatrogenic Etiology

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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