Use of perfusional angiosonography in liver transplantation and conservative management of post-transplant intra-hepatic pseudo-aneurysm

Abstract

Hepatic artery pseudo-aneurysm is a rare but severe complication of liver transplantation, which generally requires immediate surgical or angiographic treatment. The diagnosis is usually made by splanchnic percutaneous angiography. We report a case of an intra-hepatic pseudo-aneurysm after surgical correction of a thrombosed hepatic artery and its successful response to conservative management. Duplex Doppler ultrasound, associated with a new B-mode contrast-based sonographic technique, called "perfusional angiosonography", was used to diagnose the intra-hepatic pseudo-aneurysm. The combination of the two ultrasound techniques was useful in following the course of the pseudo-aneurysm, without further need for angiography. Eventually, this pseudo-aneurysm underwent spontaneous obliteration.

Late‐onset arterial hemorrhage mimicking pseudoaneurysm after living donor liver transplantation

“…1 Complications involving the HA that require reconstruction are the most serious events, and arterial complications can lead to secondary graft loss. 2 Thus, early detection and intervention are essential for the effective management of arterial complications.…”

“…1 Arterial thrombus formation at the anastomotic site is the most common complication, whereas pseudoaneurysms are rare with a reported incidence of 0.3%-2.0%. 2 It has poor clinical symptoms, but the sudden onset of massive bleeding with shock, acute abdominal pain, and unrecognized gastrointestinal bleeding is often observed in rupture cases.…”

Contrast-enhanced Ultrasound for Liver Imaging: Recent Advances

“…The role of CEUS in this setting could be to detect or to rule out extravascular spilling or artero-portal fistulas, but only a single case report is available in the literature [141].…”