EURORAD ESR

Case 9620

Hepatic artery pseudoaneurysm: a postoperative arterial complication after orthotopic liver transplantation

Author(s)
Scalise P, Angelini G, Pancrazi F, Bemi P, Bozzi E, Turini F, Faggioni L, Perrone O, Cioni R, Bartolozzi C

Department of Diagnostic and Interventional Radiology,
University Hospital of Pisa, Italy
 
Patient
female, 59 year(s)
 
 
  • Figure 1
    Pre-treatment CT
     

    CT evaluation (MIP reconstruction) in sagittal view shows the voluminous (21x17mm) pseudoaneurysmatic lesion of hepatic artery.

     
    Area of Interest: Interventional vascular; Imaging Technique: CT-Angiography; Procedure: Computer Applications-3D; Special Focus: Aneurysms;

    CT evaluation (VR reconstruction) shows the voluminous (21x17mm) pseudoaneurysmatic lesion of hepatic artery.

     
    Area of Interest: Interventional vascular; Imaging Technique: CT-Angiography; Procedure: Computer Applications-3D; Special Focus: Aneurysms;

    CT evaluation (VR reconstruction) highlights the wide communication of HA pseudoaneurysmatic lesion with the arterial lumen (3mm).

     
    Area of Interest: Interventional vascular; Imaging Technique: CT-Angiography; Procedure: Computer Applications-3D; Special Focus: Aneurysms;
     
     
  • Figure 2
    Selective hepatic artery angiography

    Selective HA angiography before stentgraft insertion confirms CT-findings of HA pseudoaneurysm.

     
    Area of Interest: Interventional vascular; Imaging Technique: Catheter arteriography; Procedure: Stents; Special Focus: Aneurysms;
     
     
  • Figure 3
    CT scan 24h later

    CT-scan performed 24h after first stent placement (MIP reconstruction) shows graft partially covering pseudoaneurysm neck due to wide communication between lesion and arterial lumen, with minimal persistence of...

     
    Area of Interest: Interventional vascular; Imaging Technique: CT-Angiography; Procedure: Computer Applications-3D; Special Focus: Aneurysms;
     
     
  • Figure 4
    Selective hepatic artery angiography
     

    Selective HA angiography performed 24h after first stentgraft placement confirms minimal persistence of arterial supplying caused by insufficient intimal stent adhesion.

     
    Area of Interest: Interventional vascular; Imaging Technique: Catheter arteriography; Procedure: Stents; Special Focus: Aneurysms;

    Due to persistence of arterial flow into the pseudoaneurysm, a further stentgraft 5x16mm situated distally and engaged to the first one that was placed. Post procedural angiogram confirms the exclusion of...

     
    Area of Interest: Interventional vascular; Imaging Technique: Catheter arteriography; Procedure: Stents; Special Focus: Aneurysms;
     
     
  • Figure 5
    Follow-up CT
     

    6-months follow-up CT evaluation shows patent and well-positioned stentgrafts.

     
    Area of Interest: Interventional vascular; Imaging Technique: CT-Angiography; Procedure: Treatment effects; Special Focus: Aneurysms;

    6-months follow-up CT evaluation shows patent and well-positioned stentgrafts.

     
    Area of Interest: Interventional vascular; Imaging Technique: CT-Angiography; Procedure: Treatment effects; Special Focus: Aneurysms;

    CT evaluation (VR reconstruction) shows well-positioned stentgrafts.

     
    Area of Interest: Interventional vascular; Imaging Technique: CT-Angiography; Procedure: Treatment effects; Special Focus: Aneurysms;
     
     
CT evaluation (MIP reconstruction) in sagittal view shows the voluminous (21x17mm) pseudoaneurysmatic lesion of hepatic artery.
 
CT evaluation (VR reconstruction) shows the voluminous (21x17mm) pseudoaneurysmatic lesion of hepatic artery.
 
CT evaluation (VR reconstruction) highlights the wide communication of HA pseudoaneurysmatic lesion with the arterial lumen (3mm).
 
Selective HA angiography before stentgraft insertion confirms CT-findings of HA pseudoaneurysm.
 
CT-scan performed 24h after first stent placement (MIP reconstruction) shows graft partially covering pseudoaneurysm neck due to wide communication between lesion and arterial lumen, with minimal persistence of arterial supplying.
 
Selective HA angiography performed 24h after first stentgraft placement confirms minimal persistence of arterial supplying caused by insufficient intimal stent adhesion.
 
Due to persistence of arterial flow into the pseudoaneurysm, a further stentgraft 5x16mm situated distally and engaged to the first one that was placed. Post procedural angiogram confirms the exclusion of pseudoaneurysm from circulation.
 
6-months follow-up CT evaluation shows patent and well-positioned stentgrafts.
 
6-months follow-up CT evaluation shows patent and well-positioned stentgrafts.
 
CT evaluation (VR reconstruction) shows well-positioned stentgrafts.
 
 
 
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