The preclose technique in PEVAR has a high technical success rate and a low groin complication rate. Technical success tends to increase with ultrasound-guided arterial access and decrease with larger access. When failure occurs, it is unilateral in the majority of cases, and conversion to surgical cutdown does not appear to increase the operative risk.
We present a case of a 46 years old female with decompensated liver cirrhosis who developed severe intraperitoneal hemorrhage secondary to inadvertent liver puncture during a paracentesis which resulted in a combined hepatic arterial and portal venous injury. The arterial injury was managed with transarterial embolization. The portal venous injury was managed with percutaneous microwave ablation. This article also highlights the importance of evaluating both arterial injury as well as portal venous injury in the setting of hepatic bleeding, particularly in patients with portal hypertension.
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