Stephenson Krista, Kalkwarf Kyle, Giorgakis Emmanouil
Division of Solid Organ Transplantation, Department of Surgery, UAMS Medical Center, AR, USA.
Division of Trauma and Critical Care Surgery, Department of Surgery, UAMS Medical Center, Little Rock, AR, USA.
Ann Hepatobiliary Pancreat Surg. 2021 Feb 28;25(1):126-131. doi: 10.14701/ahbps.2021.25.1.126.
Hepatic artery pseudoaneurysm (HAP) is a rare, highly morbid and frequently fatal complication of liver transplantation. Most are a mycotic mediated weakness of the arterial wall, with associated bacterial or fungal infection of ascitic fluid. As it is usually asymptomatic prior to rupture, the majority present in acute hemorrhagic shock and dire extremis. Resuscitative endovascular balloon occlusion (REBOA) was initially developed for the management of noncompressible hemorrhagic shock in trauma; however, remains underutilized and understudied in the non-trauma setting. We present the case of a mycotic hepatic artery pseudoaneurysm rupture due to and post directed donor orthoptic liver transplant, in which REBOA was employed in the setting of impending exsanguination as a bridge to definitive surgical intervention. Although this patient passed away of multiorgan system failure prior to re-transplant, this case demonstrates the importance of a heightened suspicion of this devastating complication, especially in the setting of bilioenteric reconstruction and perihepatic fluid collection, as well as the benefit of utilizing resuscitative techniques such as REBOA prior to definitive surgical or endovascular therapy to mitigate the high morbidity and mortality of this condition.
肝动脉假性动脉瘤（HAP）是肝移植罕见、高发病且常致命的并发症。多数是由真菌介导的动脉壁薄弱，伴有腹水的细菌或真菌感染。由于破裂前通常无症状，多数患者以急性失血性休克和极度危急状态就诊。复苏性血管内球囊阻断术（REBOA）最初是为处理创伤性不可压缩性失血性休克而研发；然而，在非创伤环境中仍未得到充分利用和研究。我们报告一例在直接供体原位肝移植后因[原因未提及]导致的真菌性肝动脉假性动脉瘤破裂病例，在即将失血过多的情况下采用REBOA作为确定性手术干预的桥梁。尽管该患者在再次移植前因多器官系统衰竭死亡，但本病例表明高度怀疑这种毁灭性并发症的重要性，尤其是在胆肠重建和肝周积液的情况下，以及在确定性手术或血管内治疗前利用REBOA等复苏技术以降低该疾病高发病率和死亡率的益处。
