Novotny Robert, Janousek Libor, Lipar Kvetoslav, Chlupac Jaroslav, Fronek Jiri
Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
First Faculty of Medicine, Charles University, Prague, Czech Republic.
Am J Case Rep. 2019 Oct 30;20:1592-1595. doi: 10.12659/AJCR.917728.
BACKGROUND Hepatic artery (HA) pseudoaneurysm (PSA) after liver transplantation (OLTx) is rare but often fatal complication requiring quick repair. Its prevalence in patients after OLTx is around 0.94%. CASE REPORT A 41-year-old female patient underwent a full-graft orthotopic liver transplantation (OLTx) for alcoholic liver cirrhosis in 2017. During regular postoperative Doppler ultrasonography (DU) check-ups, a large 3-cm pseudoaneurysm (PSA) was detected on the hepatic artery. The patient underwent a computed angiography (CTA) to verify the PSA anatomical localization and relationship with the transplanted liver graft. Selective celiac arteriography showed HA PSA and 90% stenosis of the hepatic artery after PSA. The stent graft placement was unsuccessful as the guiding wire was unable to pass through the post-PSA HA stenosis. The patient was scheduled for an open repair under general anesthesia. Through a right subcostal incision, the HA PSA was resected and the HA was mobilized and re-anastomosed using an end-to-end technique. Three months after the procedure, the patient has a good liver graft perfusion through the HA with no sign of PSA reoccurrence or stenosis. CONCLUSIONS Early detection of the HA PSA after OLTx is a life-threatening complication requiring prompt treatment. If endovascular treatment options fail, open surgical repair, despite its challenges, is the only possible treatment option.
肝移植（OLTx）术后肝动脉（HA）假性动脉瘤（PSA）较为罕见，但往往是致命的并发症，需要迅速修复。其在肝移植患者中的患病率约为0.94%。病例报告：一名41岁女性患者于2017年因酒精性肝硬化接受了全肝原位肝移植（OLTx）。在术后定期的多普勒超声（DU）检查中，在肝动脉上检测到一个3厘米的大型假性动脉瘤（PSA）。患者接受了计算机血管造影（CTA）以核实PSA的解剖定位及其与移植肝的关系。选择性腹腔动脉造影显示存在HA PSA以及PSA形成后肝动脉90%的狭窄。由于导丝无法穿过PSA形成后的HA狭窄，支架移植物置入未成功。患者计划在全身麻醉下进行开放修复。通过右肋下切口，切除了HA PSA，并游离HA，采用端端技术进行重新吻合。术后三个月，患者通过HA有良好的肝移植灌注，无PSA复发或狭窄迹象。结论：肝移植术后早期发现HA PSA是一种危及生命的并发症，需要及时治疗。如果血管内治疗方案失败，尽管存在挑战，开放手术修复是唯一可能的治疗选择。
