J Korean Soc Radiol.  2019 May;80(3):555-561. 10.3348/jksr.2019.80.3.555.

Endovascular Exclusion of Hepatic Artery Pseudoaneurysm after Living-Donor Liver Transplantation with a Stent-Graft Using Conical Remodeling: A Case Report

• Baek SD
• Kang UR
• Kim YH

• KMID: 2454035
• DOI: http://doi.org/10.3348/jksr.2019.80.3.555

Abstract

Hepatic artery complications after liver transplantation include hepatic artery thrombosis, stenosis, pseudoaneurysm (PA), and others. Among these complications, hepatic artery PA is reported to have a low incidence, but it is associated with a devastating and often fatal outcome and a high risk of rupture. Herein, we present the case of a 56-year-old male patient who underwent living-donor liver transplantation because of alcoholic liver cirrhosis. A silent PA of the hepatic artery proper was detected incidentally on computed tomography scan during routine follow-up 15 days after surgery, and was successfully excluded by implantation of a coronary balloon-expandable stent-graft using "˜conical remodeling' by two-step ballooning. This technique can be effectively used for PA of visceral arteries with tapering-small diameter, in which flow preservation is critical to patient care.

MeSH Terms

Aneurysm, False*
Arteries
Constriction, Pathologic
Fatal Outcome
Follow-Up Studies
Hepatic Artery*
Humans
Incidence
Liver Cirrhosis, Alcoholic
Liver Transplantation*
Liver*
Male
Middle Aged
Patient Care
Rupture
Stents
Thrombosis

Figure

• 

  Fig. 1 A proper hepatic artery pseudoaneurysm in a 56-year-old male patient after living-donor liver transplantation. A. CT angiography on postoperative day 15. On axial CT images, the pseudoaneurysm (arrowhead) is located in the posteroinferior aspect of the hepatic artery proper (arrow). A peri-hepatic hematoma (curved arrow) is seen. B. On postoperative day 23, celiac arteriography shows faint visualization of the pseudoaneurysm (arrowheads). Aneurysmal change of the ligated right hepatic artery stump (arrow) is also seen. C. The entire stent-graft is first expanded to 3.33 mm (oversizing by 20% to the distal target vessel) by ballooning up to 15 atm. D. The deflated balloon is pulled back slightly proximal to the stent-graft, then inflated up to 19 atm, making the diameter 3.95 mm (oversizing by 20%) for the proximal target vessel. E. Post-deployment celiac arteriography shows the conical remodeled stent-graft and complete exclusion of the pseudoaneurysm. F. Maximum intensity projection image shows patent stent-graft without any evidence of pseudoaneurysm on follow-up CT angiography 17 months later. CT = computed tomography

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