Hepatic arterial pseudoaneurysm after placement of transjugular intrahepatic portosystemic shunt

Intrahepatic hematoma secondary to transjugular intrahepatic portosystemic stent-shunt procedure: Case report and literature review

RATIONALE

Transjugular intrahepatic portosystemic stent-shunt (TIPSS) is a minimally invasive procedure used for the treatment of portal hypertension. Intrahepatic hematoma is the rare complication caused by hepatic arterial injuries from TIPSS procedure.

PATIENT CONCERNS

This case report illustrated a 77-year-old man with hepatitis B virus-induced cirrhosis who underwent TIPSS.

DIAGNOSES

The patient suffered from intrahepatic hematoma and hepatic pseudoaneurysm because of the hepatic artery injury after TIPSS.

INTERVENTIONS

The hepatic artery laceration began at the level of the branch of the left hepatic artery was embolized.

OUTCOMES

The acute intrahepatic hematoma and hepatic pseudoaneurysm of the patient were cured.

CONCLUSION

In this report, we describe a cirrhosis patient with a large intrahepatic hematoma secondary to TIPSS, and a literature review is also presented. The intrahepatic hematoma and hepatic pseudoaneurysm should be paid more attention after TIPSS while early-stage prevention should be carried out.

False aneurysm of a hepatic artery branch complicating intrahepatic islet transplantation

Islet transplantation, an innovative treatment strategy for type 1 diabetes mellitus, is a relatively safe procedure, with less morbidity than pancreas transplantation. Vascular injuries have not been reported to date. We report a percutaneous transhepatic intraportal islet transplant infusion that was followed by bleeding from a false aneurysm of an intrahepatic branch of the hepatic artery. The bleeding was controlled by selective embolization. Despite the complication and its treatment, the patient gained insulin independence, which was sustained for 285 days. She is currently on a small dose of insulin with good glycemic control.

Iatrogenic hepatic artery pseudoaneurysms: an uncommon complication after hepatic, biliary, and pancreatic procedures

Hepatic artery pseudoaneurysms are uncommon but potentially lethal complications of hepatic, biliary, and pancreatic interventions. To enhance our knowledge about these pseudoaneurysms, we reviewed our institution's experience with the management of these lesions. We reviewed the literature on 136 cases of hepatic artery pseudoaneurysms as well as our experience with 17 patients (excluding patients who were post-transplantation or had suffered abdominal trauma). The causes, pathogenesis, and clinical features were analyzed. Ten women and seven men developed hepatic artery pseudoaneurysms after undergoing hepatic (65%), biliary (30%), or pancreatic procedures (5%). The mean time between initial intervention and diagnosis was 5.7 months (range 7 days-38 months). Rupture occurred in 13 patients (76%). Mean pseudoaneurysm size was 1.9 cm (range 0.7-4 cm). Embolization was successful in 12 of 14 patients (86%). Four patients (24%), including the two who failed embolization, required operative intervention. Postoperative mortality was 25% while postembolization mortality was 14%. One patient was observed, and the aneurysm thrombosed at 72 months follow-up. Mean follow-up was 48 months (range 1-184 months) for 13 of the 14 survivors (93%) (1 patient was lost to follow-up) without any clinical sequela. Hepatic artery pseudoaneurysms are rare. Rupture is common and occurred in 76% of patients. For both ruptured and nonruptured cases angiography with embolization of the pseudoaneurysm is safe and effective. Operative intervention should be reserved for patients for whom embolization fails or for whom it is not feasible.