Hepatic artery aneurysm rupture in a woman with primary antiphospholipid syndrome

Vancheri, Federico; Dovico, Rossana; Croce, E.; Falco, Giuseppe

doi:10.1177/0961203307076723

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…Pregnancy can easily lead to the worsening of CTDs. Clinicians should be aware that CTDs, especially SLE and APS, can also put pregnancies at significantly high risk of placental insufficiency, such as FGR and preeclampsia ( 17 , 18 ). The best pregnancy outcome can be achieved by performing multidisciplinary management and paying attention to the evaluation and treatment of basic diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Periportal hemorrhage and intravascular fibrin deposition play an important role in hepatic sinus obstruction and massive intravascular congestion, leading to elevated intrahepatic pressure and infarction development, and subcapsular hematoma and intraparenchymal hemorrhage ( 16 ). The hypercoagulable state and microthrombosis related to OAPS may further aggravate this situation ( 17 ). In addition, the application of high-dose LMWH will increase the risk of spontaneous visceral hemorrhage, although it is extremely rare ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

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An advanced understanding of the heterogeneous clinical features of “non-criteria” obstetric antiphospholipid syndrome: Two case reports and a literature review

Xue

Tan²,

Xing³

2023

Front. Immunol.

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Antiphospholipid syndrome (APS) is an acquired autoimmune disorder characterized by recurrent venous and/or arterial thrombosis and/or pregnancy complications, in the presence of elevated antiphospholipid (aPL) antibodies. APS in pregnant women is referred to as “obstetrical” APS (OAPS). The diagnosis of definite OAPS requires the presence of one or more typical clinical criteria and persistent aPL antibodies at least 12 weeks apart. However, the classification criteria for OAPS have generated wide discussion, with a growing impression that certain patients not fully meeting these criteria might be inappropriately excluded from the classification, which is known as “non-criteria” OAPS. We present here two unique cases of potentially lethal “non-criteria” OAPS, complicating severe preeclampsia, fetal growth restriction (FGR), liver rupture, preterm birth, refractory recurrent miscarriages, or even stillbirth. We further share our diagnostic search and analysis, treatment adjustment, and prognosis for this unusual antenatal event. We will also present a short review of an advanced understanding of the pathogenetic mechanisms of this disease, heterogeneous clinical features, and potential significance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

An advanced understanding of the heterogeneous clinical features of “non-criteria” obstetric antiphospholipid syndrome: Two case reports and a literature review

Xue

Tan²,

Xing³

2023

Front. Immunol.

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“…Hepatic involvement is not uncommon in patients with APS. Previous reports have described hepatic artery aneurysm, 11 hepatic vein thrombosis (Budd-Chiari syndrome), hepatic infarction, and inflammatory and cirrhotic conditions associated with APS/aPL. 12 To our knowledge, hepatic artery stenosis with abdominal symptoms has not been reported previously.…”

mentioning

confidence: 99%

Hepatic Artery Stenosis in Antiphospholipid Syndrome

Simões

Davies

Sangle

et al. 2011

Clin Appl Thromb Hemost

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Antiphospholipid syndrome (APS) is characterized by pregnancy morbidity and thrombosis (arterial and venous) in association with antiphospholipid antibodies (aPL). 1 Recently, a number of publications have demonstrated the presence of arterial stenosis in patients with APS, although the exact etiology remains unclear. 2 We report a patient with APS associated with long-standing abdominal symptoms and hepatic artery stenosis. A 36-year-old female with systemic lupus erythematosus (SLE) and lupus nephritis had been receiving mycophenolate mofetil, low-dose prednisolone, and hydroxychloroquine for the last 2 years. She was a smoker (10 pack years) and had no other conventional cardiovascular risk factors. She had a history of seizures and symptoms suggestive of transient ischemic attacks. The lupus anticoagulant (dilute Russell's viper venom time [dRVVT]) was positive more than twice 12 weeks apart and magnetic resonance imaging brain scan showed high-density signals suggestive of small vessel ischemia. She was diagnosed with APS and commenced warfarin therapy. She developed abdominal pain over 4 years which was exacerbated after food and was associated with bloating, nausea, urgency to defecate, and weight loss. She did not have vomiting, diarrhea, or rectal bleeding. Her hemoglobin was 10.2 g/dL and hepatic transaminases were within normal limits. Upper gastrointestinal endoscopy, flexible sigmoidoscopy, and colonoscopy were normal and serology was negative for celiac disease antibodies, smooth muscle, and antimitochondrial antibodies. Magnetic resonance imaging angiography of the celiac axis showed a tight stenosis just distal to the origin of the common hepatic artery, with a patent gastroduodenal artery providing a collateral pathway (Figure 1). A number of case reports and series have described arterial stenosis in the renal, 3 celiac, 4 and cerebral 5 arteries in patients with APS. These stenoses are described as smooth and well delineated, quite different from those seen in patients with atherosclerosis and fibromuscular dysplasia. Some reports have suggested that anticoagulation treatment may improve or prevent further progression of the stenosis. 6

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Visceral Artery Aneurysms

Dougherty¹,

Calligaro²

2004

Haimovici's Vascular Surgery

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Hepatic artery aneurysm rupture in a woman with primary antiphospholipid syndrome

Cited by 5 publications

References 14 publications

An advanced understanding of the heterogeneous clinical features of “non-criteria” obstetric antiphospholipid syndrome: Two case reports and a literature review

An advanced understanding of the heterogeneous clinical features of “non-criteria” obstetric antiphospholipid syndrome: Two case reports and a literature review

Hepatic Artery Stenosis in Antiphospholipid Syndrome

Visceral Artery Aneurysms

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