Early Detection of a Hepatic Artery Pseudoaneurysm After Liver Transplantation Is the Determinant of Survival

Jeng, Kuo‐Shyang; Huang, Chun‐Chieh; Lin, Cheng‐Kuan; Liang, Cheng‐Chao; Chung, Chen‐Shuan; Weng, Meng Tzu; Chen, K.-H.

doi:10.1016/j.transproceed.2015.11.017

Cited by 10 publications

(15 citation statements)

References 26 publications

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“…Hepatic artery pseudoaneurysm (HAPA) is a rare and potentially fatal complication of liver transplantation [1][2][3][4][5][6][7][8][9][10][11][12]. Reported incidence ranges between 0.3% and 2.6%, with associated mortality reported as high as 75% [1][2][3][4][5][6][7][8][9][10][11][12]. While the precise pathogenesis is not fully understood, it is likely a combination of surgical vascular manipulation at the arterial anastomotic site and localized infection in the setting of a compromised immune system [1][2][3][4][5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…Reported incidence ranges between 0.3% and 2.6%, with associated mortality reported as high as 75% [1][2][3][4][5][6][7][8][9][10][11][12]. While the precise pathogenesis is not fully understood, it is likely a combination of surgical vascular manipulation at the arterial anastomotic site and localized infection in the setting of a compromised immune system [1][2][3][4][5][6][7][8][9][10][11][12]. Other factors, such as surgical complications, reoperations, bile leak and interventional procedures [1][2][3]6] may also play a role in the development of HAPA.…”

Section: Introductionmentioning

confidence: 99%

“…It is most frequently diagnosed within 60 days of transplant [1][2][3][4][5][6][7][8][9][10][11][12] but may not be recognized until years later [3,6,10]. Clinical presentation typically includes a combination of severe abdominal pain, gastrointestinal bleeding, or hemodynamic instability as the HAPA is unrecognized until rupture [1][2][3][4][5][6][7][8][9][10][11][12]. Elevated liver function tests secondary to obstructive gra dysfunction caused by an unruptured HAPA may also be present [9,11].…”

Section: Introductionmentioning

confidence: 99%

“…A high clinical index of suspicion, rapid recognition [1][2][3][4][5][6][7][8][9][10][11][12] and radiographic con rmation of HAPA is necessary for successful treatment. While computed tomography (CT), magnetic resonance imaging (MRI) and doppler ultrasonography can be useful for detection of suspected HAPA, angiography is required for de nitive diagnosis apart from diagnosis at the time of laparotomy [1-3, 6, 9-11].…”

Section: Introductionmentioning

confidence: 99%

“…While computed tomography (CT), magnetic resonance imaging (MRI) and doppler ultrasonography can be useful for detection of suspected HAPA, angiography is required for de nitive diagnosis apart from diagnosis at the time of laparotomy [1-3, 6, 9-11]. Treatment options include embolization, stenting, thrombin injection, surgical ligation or surgical excision [1][2][3][4][5]11]. We report a series of four cases of hepatic artery pseudoaneurysm in adult liver transplant recipients with the goal of identifying factors that may aid in early diagnosis of HAPA prior to the development of life threatening complications.…”

Section: Introductionmentioning

confidence: 99%

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Hepatic Artery Pseudoaneurysm in the Liver Transplant Recipient: A Case Series

Michel

Goussous

Orr

et al. 2019

Case Reports in Transplantation

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Introduction. Hepatic artery pseudoaneurysm is a rare and potentially fatal complication of liver transplantation with a reported incidence of 0.3–2.6% and associated mortality approaching 75%. Clinical presentation typically includes sudden hypotension, gastrointestinal bleed or abnormal liver function tests within two months of transplantation. We report a series of four cases of hepatic artery pseudoaneurysm in adult liver transplant recipients with the goal of identifying factors that may aid in early diagnosis, prior to the development of life threatening complications. Methods. A retrospective chart review at a high volume transplant center revealed 4 cases of hepatic artery pseudoaneurysm among 553 liver transplants (Incidence 0.72%) between March 2013 and March 2017. Results. Two of the four patients died immediately after intervention, one patient survived an additional 151 days prior to death from an unrelated condition and one patient survived at two years follow up. All cases utilized multiple imaging modalities that failed to identify the pseudoaneurysm prior to diagnosis with computed tomography angiography (CTA). Two cases had culture proven preoperative intrabdominal infections, while the remaining two cases manifested a perioperative course highly suspicious for infection (retransplant for hepatic necrosis after hepatic artery thrombosis and infected appearing vessel at reoperation, respectively). Three of the four cases either had a delayed biliary anastomosis or development of a bile leak, leading to contamination of the abdomen with bile. Additionally, three of the four cases demonstrated at least one episode of hypotension with acute anemia at least 5 days prior to diagnosis of the hepatic artery pseudoaneurysm. Conclusions. Recognition of several clinical features may increase the early identification of hepatic artery pseudoaneurysm in liver transplant recipients. These include culture proven intrabdominal infection or high clinical suspicion for infection, complicated surgical course resulting either in delayed performance of biliary anastomosis or a biliary leak, and an episode of hypotension with acute anemia. In combination, the presence of these characteristics can lead the clinician to investigate with appropriate imaging prior to the onset of life threatening complications requiring emergent intervention. This may lead to increased survival in patients with this life threatening complication.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Hepatic Artery Pseudoaneurysm in the Liver Transplant Recipient: A Case Series

Michel

Goussous

Orr

et al. 2019

Case Reports in Transplantation

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Liver Transplantation and Hepatic Vessels

Sarwa

2021

Vascular Disorders of the Liver

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Delayed Postoperative Hemorrhage Complicating Major Supramesocolic Surgery Management and Outcomes

et al. 2021

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Aux membres du jury :Monsieur le Professeur Mircea CHIRICA, pour m'avoir très largement accompagné dans cet exercice de thèse, pour le temps que vous passez pour la formation des internes et assistants, soyez sûr de mon profond respect.Monsieur le Professeur Pierre BOUZAT, de me faire l'honneur de faire partie de ce jury, pour votre expérience, et l'élan que vous inculquez à toute l'équipe du bloc des urgences et de l'anesthésieréanimation grenobloise.Monsieur le Professeur Ivan BRICAULT, de me faire l'honneur de faire partie de ce jury, pour votre oeil expert en imagerie abdominale et pour nos discussions futures à ce sujet. Monsieur leDocteur Julio ABBA, pour votre passion communicative et motrice, votre expérience en chirurgie d'urgence, et votre bienveillance à mon égard ; soyez assuré de ma sincère reconnaissance. Monsieur le Docteur Fabien STENARD, pour votre affection pour l'enseignement, votre perfectionnisme, et votre ambition de toujours améliorer la qualité des soins, je vous assure de mon profond respect. 7 Aux professionnels, qui ont participé et participe encore à ma formation : Le service de chirurgie digestive et viscérale du CHU de Grenoble : Monsieur le Professeur FAUCHERON, pour ses enseignements et sa bienveillance. Madame le Professeur ARVIEUX, pour son accueil et son expérience. Monsieur le Dr RISSE pour son pragmatisme et son professionnalisme. Monsieur le Dr RECHE pour son expérience. À tous les assistants de ce service, qui m'ont inspiré, par leur état d'esprit, pour autant de professionnalisme dans autant de dérision ; merci aux Dr Nicolas MOUGIN et Pierre Yves SAGE, à Nico, Jolivet, Sandrine, Bebert, Édouard et Vincent. Je pense que vous savez à quel point c'était mythique d'apprendre grâce à vous ! Les secrétaires, infirmières et tout le personnel du 12 ème pour leur travail dans la bonne humeur ! L'équipe de chirurgie orthopédique d'Annecy, des Dr CHIRPAZ et JAGER pour m'avoir laissé naïf un temps.

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Early Detection of a Hepatic Artery Pseudoaneurysm After Liver Transplantation Is the Determinant of Survival

Cited by 10 publications

References 26 publications

Hepatic Artery Pseudoaneurysm in the Liver Transplant Recipient: A Case Series

Hepatic Artery Pseudoaneurysm in the Liver Transplant Recipient: A Case Series

Liver Transplantation and Hepatic Vessels

Delayed Postoperative Hemorrhage Complicating Major Supramesocolic Surgery Management and Outcomes

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