Treatment of obstructive jaundice caused by hepatic artery pseudoaneurysm after liver transplantation

Abstract

Rationale: Despite vast improvements in technique, several complications still challenge surgeons and medical practitioners alike, including biliary and vascular complications, acute and chronic rejection, and disease recurrence. Patient concerns: A 59-year-old man was admitted to hospital on July, 2016. He had hepatitis B cirrhosis related recurrent hepatocellular carcinoma and underwent living donor liver transplantation in our hospital. Diagnosis: At the time of admission, the patient's spirit, diet, sleep, normal urine and stool, and weight did not change significantly. The test indicators are as follows: total bilirubin: 100.1 μmol/L, direct bilirubin: 65.0 μmol/L. Emergency CT in the hospital after admission showed that hepatic artery pseudoaneurysm formation after liver transplantation was observed. Interventions: This patient underwent minimal invasive endovascular treatment. The demographic, clinical, and laboratory data were collected and reviewed. He was treated successfully by endovascular stent grafting and thrombolytic treatment. Outcomes: The blood concentration of tacrolimus (FK506) was 6.3 ng/mL total bilirubin 19.6 μmol/L before discharge. The changing of total bilirubin and direct bilirubin were investigated (Fig. 1). The patient recovered well and was discharged 2 weeks later. The patient is doing well and regularly followed up. Lessons: Coil embolization of aneurysmal sac or placement of a stent graft is a minimally invasive alternative to surgery and definitively excludes a bleeding hepatic artery pseudoaneurysm. This technique can be considered as an effective treatment option for hepatic artery pseudoaneurysm instead of a difficult surgical repair.

Fulminant Hepatitis as the First Presentation of Wilson’s Disease

“…Pseudoaneurysm accounts for 6 to 10% of vascular complications after transplantation. 4 It can present itself through symptoms such as hemobilia, fever, liver dysfunction and gastrointestinal bleeding, alterations evidenced in this case. At present, it is an indication for urgent treatment to avoid the loss of the transplanted organ, which ends up occurring in 1-2% of cases.…”

“…At present, it is an indication for urgent treatment to avoid the loss of the transplanted organ, which ends up occurring in 1-2% of cases. 4 In addition, the patient also developed late thrombosis of the hepatic artery, the most frequent and severe vascular complication of liver transplantation, with an incidence of 2-9% in adults and a mortality rate of 11-35%, being the main cause of primary dysfunction and graft loss. Factors associated with its incidence include the technique used in the anastomosis, dissection of the artery wall, the donor's advanced age (> 60 years), state of hypercoagulability in the recipient, and cases of rejection or infection by cytomegalovirus.…”

Case report: Immediate revascularization for symptomatic hepatic artery pseudoaneurysm after orthotopic liver transplantation? A case series and literature review

“…The treatment of HAPA after liver transplantation should be guided by (i) the clinical condition of the patient, (ii) the vascularization of the allograft, and (iii) finally the location of the aneurysm. Although an endovascular approach is without doubt an attractive solution to a difficult problem, one should keep in mind that the HAPA is frequently infected in the transplant setting ( 28 , 39 ). An intraluminal stent may, therefore, act as an infectious nidus.…”

The Role of Sonography in a Rare Case of Hepatic Artery Pseudoaneurysm: A Case Study Report

“…HAPs are rare and potentially life-threatening if left untreated. These pseudoaneurysms can arise as a surgical complication of liver transplantation 4 or as a result of an underlying inflammatory process like polyarteritis nodosa. 1,5 HAPs have also occurred in patients with a preceding diagnosis of fibromuscular dysplasia 6 and pancreatic pseudocysts.…”