Mycotic pseudoaneurysms after liver transplantation

Area of Science:

• Vascular Surgery
• Hepatology
• Transplantation Medicine

Background:

• Visceral artery aneurysms are commonly caused by arteriosclerosis.
• Vascular manipulation during liver transplantation can lead to mycotic pseudoaneurysms.
• Interventional techniques like embolization are common treatments, with surgery reserved for failures.

Observation:

• A patient developed a febrile syndrome two months post-orthotopic liver transplantation.
• Imaging revealed hepatic artery aneurysm, thrombosis, and portal anastomosis stenosis.
• The patient experienced gastrointestinal bleeding and shock due to a ruptured mycotic pseudoaneurysm.

Findings:

• The mycotic pseudoaneurysm of the common hepatic artery ruptured into the bile tract, causing hemobilia.
• Severe necrosis of the liver graft necessitated its removal.
• The patient's condition deteriorated, leading to death while awaiting a re-transplant.

Implications:

• This case underscores the potential for serious vascular complications following liver transplantation.
• Early diagnosis and management of hepatic artery pseudoaneurysms are crucial.
• The risk of mycotic pseudoaneurysms warrants consideration in post-transplant surveillance.