Shockwave Lithotripsy Facilitates Large-Bore Vascular Access Through Calcified Arteries

Abstract

Objective: Hepatic artery pseudoaneurysm is a rare but morbid complication after liver transplantation. Treatment options include ligation and endovascular embolization, followed by revascularization. We describe a new endovascular approach by stent exclusion in a high-risk patient. Methods: A 62-year-old man who received a second liver transplant after failed allograft presented with hemobilia and was diagnosed with a hepatic artery pseudoaneurysm in the setting of infection. Given his hostile abdomen, an endovascular approach was sought. We excluded the mycotic pseudoaneurysm with multiple covered stent grafts extending from the common hepatic artery to the right and left hepatic artery. He was discharged with long-term antibiotics. Results: On the 6-month follow-up visit, the stent was patent and hepatic function was stable. Conclusions: Endovascular stent graft placement for management of hepatic artery pseudoaneurysm after liver transplantation should be considered a lower morbidity alternative to surgical repair, even in the setting of infection.