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Published on: June 27, 2025
Endovascular treatment of active bleeding after liver transplant
Ali Harman1, Fatih Boyvat, Baris Hasdogan
1Department of Radiology, Baskent University Faculty of Medicine, Ankara, Turkey. aliharman@baskent-ank.edu.tr
Insights
Interventional radiology effectively manages arterial bleeding after liver transplant. Endovascular techniques stopped bleeding in 13 of 14 patients, demonstrating high success rates for these complications.
Area of Science:
- Transplant Surgery
- Interventional Radiology
- Vascular Medicine
Background:
- Active bleeding is a serious complication after liver transplantation.
- Bleeding can arise spontaneously or secondary to interventions.
Purpose of the Study:
- To assess the incidence of active bleeding complications post-liver transplant.
- To evaluate the effectiveness of interventional radiology in managing these bleeds.
Main Methods:
- Retrospective review of 14 liver transplant patients with active bleeding (June 2000 - February 2007).
- Treatment involved endovascular techniques including coils, glue, and graft-covered stents.
- Analysis of spontaneous bleeding causes and bleeding related to interventions.
Main Results:
- Endovascular intervention successfully controlled active bleeding in 13 out of 14 patients.
- Embolization with coils or glue achieved technical success.
- One patient required reoperation due to graft-covered stent failure for hepatic artery bleeding.
Conclusions:
- Interventional radiologic techniques offer successful management for arterial bleeding complications following liver transplantation.
- These techniques are effective for both early and late postoperative bleeding, regardless of cause.
Objectives:
To evaluate the incidence of active bleeding complications following transplant and the efficacy of interventional radiologic management.
Materials And Methods:
Between June 2000 and February 2007, 14 liver transplant patients with active bleeding were treated via endovascular techniques (coils, glue, or graft-covered stents). Active bleeding was spontaneous in 6 patients through the inferior epigastric artery (n=1), the inferior phrenic artery (n=1), the superior mesenteric artery (n=2), the internal mammary artery (n=1), and the hepatic artery (n=1). In 8 patients, active bleeding was due to transhepatic biliary or endovascular interventions. Hemobilia (n=2) due to pseudoaneurysm formation after transhepatic biliary interventions was embolized with coils. Hepatic artery rupture was observed in 6 patients during endovascular interventions performed on hepatic artery stenosis or thrombosis that had been treated with graft-covered stents. Technical success, clinical improvement, and complications were documented.
Results:
Active bleeding was stopped by endovascular intervention in 13 of 14 patients. Embolizations with coils or glue were successful. In 1 patient with hepatic artery bleeding, the graft-covered stent failed to seal the rupture site, and this patient underwent reoperation.
Conclusion:
Arterial bleeding complications after liver transplant during the early and late postoperative period, due either to spontaneous active bleeding or to percutaneous or endovascular interventions, can be successfully managed with interventional radiologic techniques.
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