Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea.
Liver Transpl. 2009 Nov;15(11):1535-41. doi: 10.1002/lt.21885.
Splenic artery aneurysms (SAAs), occurring in 7% to 17% of patients with cirrhosis, often result in catastrophic rupture after liver transplantation. We had experienced 3 cases of ruptured SAAs after adult living donor liver transplantation (LDLT), and we then performed this study to find risk factors for coexisting SAAs in liver transplant candidates with cirrhosis and to propose ideal approaches for them. Preoperative and postoperative computed tomography angiograms and axial views were reviewed for 310 adult LDLT recipients who had cirrhosis from January 2004 to August 2005. The recorded variables were the preoperative diagnosis, the presence of SAA and its characteristics, the splenic artery (SA) diameter, and the presence and size of portosystemic collaterals. Devastating SAA rupture accompanied by hypovolemic shock occurred on postoperative days 6, 82, and 8, respectively, and it was treated emergently by embolization in cases 1 and 2 and by splenectomy in case 3. Cases 1 and 3 recovered well, but case 2 died of an unrelated cause with a long hospital stay. The incidence of SAA during the study period was 14.2% (44/310), and the size was 16.6 +/- 5.7 mm. Most SAAs were single (70.6%, 31/44) and were located in the distal one-third of the SA (82.4%, 36/44). Large portosystemic collaterals demonstrating longstanding severe portal hypertension were significantly correlated with the occurrence of SAAs. Nine patients with SAAs were preventively treated by proximal ligation (n = 4) intraoperatively and by embolization (n = 5) 1 day before or after LDLT. No patient showed severe postembolization syndrome. In conclusion, a careful preoperative evaluation of SAAs by high-resolution 3-dimensional computed tomography in liver transplant candidates, especially in those showing large portosystemic collaterals, is merited. Preventive treatment should be encouraged regardless of the size in order to avoid severe morbidity and mortality related to SAA rupture, and methods such as radiological and surgical interventions need to be individualized according to the location and number of SAAs.
脾动脉瘤（SAAs）在肝硬化患者中的发生率为 7%至 17%，常导致肝移植后灾难性破裂。我们曾在成人活体供肝移植（LDLT）后经历过 3 例破裂的 SAA，因此进行了这项研究，以寻找肝硬化肝移植候选者中并存 SAA 的危险因素，并为他们提出理想的方法。回顾了 2004 年 1 月至 2005 年 8 月间接受 LDLT 的 310 例肝硬化成人患者的术前和术后 CT 血管造影和轴位图像。记录的变量包括术前诊断、SAA 的存在及其特征、脾动脉（SA）直径以及门体侧支循环的存在和大小。术后第 6、82 和 8 天，分别出现了伴有低血容量性休克的毁灭性 SAA 破裂，并在第 1 和第 2 例中通过栓塞治疗，在第 3 例中通过脾切除术治疗。第 1 和第 3 例患者恢复良好，但第 2 例患者因长期住院而死于与无关原因。研究期间 SAA 的发生率为 14.2%（44/310），大小为 16.6±5.7mm。大多数 SAA 为单发（70.6%，31/44），位于 SA 的远端三分之一（82.4%，36/44）。表明长期严重门静脉高压的大的门体侧支循环与 SAA 的发生显著相关。9 例 SAA 患者在术前通过高分辨率 3 维 CT 仔细评估 SA，特别是在显示大的门体侧支循环的患者中，这是值得的。应鼓励预防性治疗，无论 SAA 大小如何，以避免与 SAA 破裂相关的严重发病率和死亡率，并且根据 SAA 的位置和数量，需要个体化选择放射和手术干预方法。
