Harman Ali, Boyvat Fatih, Hasdogan Baris, Aytekin Cuneyt, Karakayali Hamdi, Haberal Mehmet
Department of Radiology, Baskent University Faculty of Medicine, Ankara, Turkey.
Exp Clin Transplant. 2007 Jun;5(1):596-600.
To evaluate the incidence of active bleeding complications following transplant and the efficacy of interventional radiologic management.
Between June 2000 and February 2007, 14 liver transplant patients with active bleeding were treated via endovascular techniques (coils, glue, or graft-covered stents). Active bleeding was spontaneous in 6 patients through the inferior epigastric artery (n=1), the inferior phrenic artery (n=1), the superior mesenteric artery (n=2), the internal mammary artery (n=1), and the hepatic artery (n=1). In 8 patients, active bleeding was due to transhepatic biliary or endovascular interventions. Hemobilia (n=2) due to pseudoaneurysm formation after transhepatic biliary interventions was embolized with coils. Hepatic artery rupture was observed in 6 patients during endovascular interventions performed on hepatic artery stenosis or thrombosis that had been treated with graft-covered stents. Technical success, clinical improvement, and complications were documented.
Active bleeding was stopped by endovascular intervention in 13 of 14 patients. Embolizations with coils or glue were successful. In 1 patient with hepatic artery bleeding, the graft-covered stent failed to seal the rupture site, and this patient underwent reoperation.
Arterial bleeding complications after liver transplant during the early and late postoperative period, due either to spontaneous active bleeding or to percutaneous or endovascular interventions, can be successfully managed with interventional radiologic techniques.
评估肝移植后活动性出血并发症的发生率以及介入放射学治疗的疗效。
2000年6月至2007年2月期间，14例肝移植术后出现活动性出血的患者接受了血管内治疗技术（弹簧圈、胶水或覆膜支架）。6例患者为自发性活动性出血，出血部位分别为腹壁下动脉（1例）、膈下动脉（1例）、肠系膜上动脉（2例）、胸廓内动脉（1例）和肝动脉（1例）。8例患者的活动性出血是由于经肝门胆管或血管内介入操作所致。2例经肝门胆管介入操作后形成假性动脉瘤导致的胆道出血，采用弹簧圈栓塞治疗。6例患者在对肝动脉狭窄或血栓进行血管内介入治疗时，采用覆膜支架，过程中出现肝动脉破裂。记录技术成功率、临床改善情况及并发症。
14例患者中有13例经血管内介入治疗后活动性出血停止。弹簧圈或胶水栓塞治疗成功。1例肝动脉出血患者，覆膜支架未能封闭破裂部位，该患者接受了再次手术。
肝移植术后早期和晚期因自发性活动性出血或经皮或血管内介入操作导致的动脉出血并发症，可通过介入放射学技术成功治疗。
