Division of Vascular Interventional Radiology, Department of Radiology, University of Virginia Health System, 1215 Lee Street, PO Box 800170, Charlottesville, VA 22908, USA.
Cardiovasc Intervent Radiol. 2013 Feb;36(1):118-27. doi: 10.1007/s00270-012-0408-y. Epub 2012 May 31.
To characterize extrahepatic pseudoaneurysm regarding incidence and etiology and determine the effectiveness of endovascular management.
A retrospective audit of 1,857 liver transplants in two institutions was performed (1996-2009). Recipients' demographics, clinical presentation, transplant type, biliary anastomosis, and presence of biliary endoprostheses were noted. Pseudoaneurysms were classified into iatrogenic (associated with biliary endoprosthesis or angioplasty) or spontaneous extrahepatic pseudoaneurysms. Spontaneous and iatrogenic pseudoaneurysms were compared for time from transplant, presenting symptoms, location in the arterial anatomy, and 3-month graft survival. Arterial patency and 6-month graft survival were calculated.
Twenty pseudoaneurysms were found (1.1 %, 20/1,857): 9 (0.5 % of transplants, 9/1,857) were spontaneous and 11 (0.6 % of transplants, 11/1,857) were "iatrogenic" (due to minimally invasive procedures: 4 angioplasty and 7 biliary endoprostheses). Sixty percent (12/20) underwent endovascular management (4 coil embolization and 8 stent-grafts). Technical success was 83 % (10/12) with a mean arterial patency of 70 % (follow-up mean, 4.9; range, 0-18 months). The 1-, 3-, and 6-month graft survival was 70, 40, and 35 %, respectively.
Due to minimally invasive procedures, posttransplant extrahepatic pseudoaneurysms are no longer an exclusive complication of the transplant surgery itself. Endovascular management is effective to stabilize patients but has not improved historic postsurgical graft survival.
描述肝外假性动脉瘤的发生率和病因，并确定血管内治疗的效果。
对两个机构的 1857 例肝移植患者进行回顾性审计（1996-2009 年）。记录受者的人口统计学、临床表现、移植类型、胆道吻合术和胆道内支架的存在情况。假性动脉瘤分为医源性（与胆道内支架或血管成形术相关）或自发性肝外假性动脉瘤。比较自发性和医源性假性动脉瘤从移植到出现症状的时间、动脉解剖部位和 3 个月移植物存活率。计算动脉通畅率和 6 个月移植物存活率。
发现 20 个假性动脉瘤（1.1%，20/1857）：9 个（0.5%的移植，9/1857）为自发性，11 个（0.6%的移植，11/1857）为“医源性”（由于微创程序：4 例血管成形术和 7 例胆道内支架）。60%（20/33）接受了血管内治疗（4 例线圈栓塞和 8 例支架移植）。技术成功率为 83%（10/12），平均动脉通畅率为 70%（随访平均，4.9；范围，0-18 个月）。1、3 和 6 个月的移植物存活率分别为 70%、40%和 35%。
由于微创程序，肝外假性动脉瘤不再是移植手术本身的特有并发症。血管内治疗可有效稳定患者病情，但并未改善术后历史移植物存活率。
