Hepatic artery pseudoaneurysm after liver transplantation: a case report

Background: The most common hepatic artery complications after Liver Transplantation (LT) are hepatic artery stenosis, thrombosis and pseudoaneurysm, which can all cause ischemia in the grafted liver. As one of the main complications, the Hepatic Artery Pseudoaneurysm (HAP) is rare with the incidence of about 2%, but its consequence may be most devastating or even fatal. Methods: Here, we presented a 57 y old male patient, who underwent LT due to Hepatocellular Carcinoma (HCC), with previous history of several times of Transhepatic Arterial Chemoembolization (TACE). This patient suffered from grafted liver ischemia on the 3rd postoperative day. Initially, this case was misdiagnosed as hepatic artery thrombosis, as the hepatic arterial blood flow could not be found by Doppler ultrasound or the hepatic angiography. Subsequently, thrombolysis was adopted, which leaded to abdominal haemorrhage rather than recanalization. Immediately, the laparotomy was exploited, which showed that the ischemia was caused by HAP rather than hepatic artery thrombosis. Finally, the HAP was surgically removed and the LT was successful. Conclusion: For patients after LT, HAP should be considered when the hepatic blood flow is very low or even hardly be detected by ultrasound in particular after angiogram. Besides, HAP should also be suspected when the haemorrhage occurred during the thrombolysis but the hepatic arterial blood flow remained unimproved, especially for patient with TACE history.