Splenic artery aneurysm and orthotopic liver transplantation

Abstract

Splenic artery aneurysms are a rare but potentially fatal complication after liver transplantation. We report three cases presenting in a 12-month period in adult patients who underwent transplantation for chronic liver disease. Doppler ultrasound of the splenic artery should be performed in all patients with cirrhosis and portal hypertension who are being assessed for liver transplantation. The aneurysm can be ligated at the time of transplantation.

Complications of Orthotopic Liver Transplantation: Spectrum of Findings with Helical CT

“…These patients are also at higher risk for splenic artery aneurysm rupture in the posttransplantation period, especially if the aneurysm is larger than 1.5 cm in diameter (39), owing to decreased portal vein pressure and increased splenic artery flow, which may cause splenic artery aneurysms to expand and rupture (40,41). Preoperative study is necessary to detect splenic artery aneurysms, since this area is not routinely explored during transplantation surgery.…”

The management of splenic artery aneurysm in patients awaiting liver transplantation

“…Most SAAs in this group are diagnosed on elective imaging as part of the diagnostic work-up for liver transplantation; however, some present emergently with rupture. Most SAAs can be managed with coil embolization, although N-butyl-2-cyanoacrylate gel injection has also been used for sealing leaking aneurysms (8,9). Occasionally, patients may present with an upper gastrointestinal bleed as a result of erosion and bleed into the stomach.…”

“…Endovascular treatment of SAAs provides a non-invasive alternative to major surgery in patients with liver disease, reducing the risk of surgical morbidity as well as increasing the operative risk of a subsequent liver transplant as a result of collateral circulation associated with portal hypertension. Most SAAs can be managed with coil embolization, although N-butyl-2-cyanoacrylate gel injection has also been used for sealing leaking aneurysms (8,9). This approach carries a risk of post-embolization syndrome with the development of splenic infarcts and abscess, as well as the risk of incomplete sealing of the aneurysm with persistent filling of the aneurysmal sac.…”

Pediatric Liver Transplantation

“…55 A rare cause of hemorrhage is a preexisting splenic artery aneurysm rupture. 62,63 Preoperative computed tomography (CT) scans or abdominal ultrasounds may identify the lesion. Treatment is ligation of the splenic artery at the time of transplantation.…”