Trends in the Treatment of Hepatic Artery Pseudoaneurysm After Liver Transplantation

OBJECTIVES: Hepatic artery pseudoaneurysm (HAP) is a rare complication after liver transplantation with significant morbidity and mortality. Infection, as well as instrumentation, is associated with the development of HAP in this patient population. There is currently no consensus on the routine management of HAP after transplant.
METHODS: A retrospective review of a prospectively gathered database including all patients who underwent liver transplantation at our institution (UNOS accredited) from January 1998 to June 2007 was performed. Following patient identification, a complete patient chart review was conducted.
RESULTS: Nine patients out of a total of 445 liver transplants (2%) were identified as having developed a post-operative HAP. Eight patients were orthotopic liver transplant recipients and one patient received a piggyback liver transplant. A total of 9 HAP’s developed post-operatively and all were radiographically identified at the site of arterial anastomosis. Seven of the 9 patients were febrile prior to diagnosis and had documented positive blood or intra-operative tissue cultures. One patient developed an HAP after balloon angioplasty of an anastomotic stricture.
Surgical repair was performed as primary treatment for 5 patients and as salvage treatment for 2 after failed endovascular attempts. Of those treated surgically, 2 expired (sepsis, massive hepatic infarct) and one required re-operation for graft thrombosis. One patient expired due to sepsis following endovascular treatment.
CONCLUSIONS: HAP remains a rare but devastating complication following liver transplantation. There may be an association with infection that leads to their development. Both open and endovascular treatment may be possible but are still associated with significant morbidity and mortality. In the setting of infection, endovascular treatment in not recommended.