What is the prevalence and cause of pseudoaneurysm following whole-liver orthotopic liver transplantation (OLTX)?

Updated: Mar 01, 2019
  • Author: Paul D Russ, MD; Chief Editor: John Karani, MBBS, FRCR  more...
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Answer

Extrahepatic pseudoaneurysms occur after OLTX in approximately 2% of patients with a mortality following rupture of nearly 69%. [30]  Early detection is a key determinant of survival. [31] The most common location of pseudoaneurysm formation is at the donor-recipient arterial anastomosis. A less common site is the ligation of the donor gastroduodenal artery. Pseudoaneurysms can be caused by infection or technical failure. Because of the potential for rupture and life-threatening hemorrhage, pseudoaneurysms need to be treated promptly. To ensure maximum arterial flow, most extrahepatic lesions are repaired surgically.

Intrahepatic pseudoaneurysms usually result from percutaneous biopsy, biliary procedures, or infection. Pseudoaneurysms, particularly if mycotic, can result in fistulas to the PV or biliary tree. Intrahepatic pseudoaneurysms or arterial fistulas can cause hemobilia, gastrointestinal bleeding, and hemoperitoneum. Most intrahepatic lesions can be treated by transcatheter embolization or stent placement. Direct percutaneous puncture with a 22-gauge needle followed by the injection of coils or particulate thrombotic agents is sometimes necessary.


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