Zhang Jackie, Khalifeh Ali, Santini-Dominguez Rafael, Barth Rolf N, Bruno David, Desikan Sarasijhaa, Gupta Anuj, Toursavadkohi Shahab
Division of Vascular Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, MD.
Division of Vascular Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, MD.
Ann Vasc Surg. 2019 Nov;61:473.e7-473.e11. doi: 10.1016/j.avsg.2019.05.060. Epub 2019 Aug 5.
Hepatic artery pseudoaneurysm is a rare but very morbid complication after liver transplant. Treatment options include ligation or endovascular embolization, followed by revascularization. We describe a new endovascular approach by stent exclusion in a high-risk patient.
A 62-year-old male 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 arteries. He was discharged with long-term antibiotics. On his 6-month follow-up visit, his stent was patent and hepatic function was stable.
Endovascular stent-graft placement for management of hepatic artery pseudoaneurysm after liver transplant should be considered as a lower morbidity alternative to surgical repair, even in the setting of infection.
肝动脉假性动脉瘤是肝移植术后一种罕见但极具危害性的并发症。治疗选择包括结扎或血管内栓塞，随后进行血管重建。我们描述了一种在高危患者中通过支架置入术进行血管腔内治疗的新方法。
一名62岁男性，在首次肝移植失败后接受了再次移植，出现胆道出血，并在感染情况下被诊断为肝动脉假性动脉瘤。鉴于其腹腔粘连严重，故寻求血管腔内治疗方法。我们使用多个覆膜支架从肝总动脉延伸至左右肝动脉，排除了感染性假性动脉瘤。患者出院时带长期抗生素。在6个月的随访中，其支架通畅，肝功能稳定。
即使在存在感染的情况下，血管腔内支架置入术治疗肝移植术后肝动脉假性动脉瘤也应被视为一种比手术修复发病率更低的替代方法。
