生体肝移植後の肝動脈仮性動脈瘤に対してカバードステントが有効であった一例

<p>【Introduction】 Hepatic artery pseudoaneurysm after liver transplantation is a rare but devastating complication with an incidence of 0.3-2.6%. Once the pseudoaneurysm ruptures, the mortality rate becomes very high. We present a case with the hepatic artery pseudoaneurysm after living donor liver transplantation, which was successfully treated with placement of a covered stent.</p><p>【Case】 A 50-year-old man with a diagnosis of alcoholic cirrhosis underwent living-donor liver transplantation (LDLT) using the left lobe of his daughter as a graft. Hepatic artery anastomosis was performed in end-to-end fashion by interrupted sutures with 8-0 nylon. A bump-like projection with a diameter of 5 mm at the hepatic artery anastomosis was detected with a computed tomography (CT) scan on post-operative day (POD) 12, which was initially considered a stump of the hepatic artery but was confirmed as a pseudoaneurysm because the size of the projection increased to 8 mm with a CT scan POD 16. An expanded-polytetrafluoroethlen (ePTFE) membrane-covered stent was inserted to the anastomotic site and placed by inflating the intraluminal balloon POD 17 after the confirmation of the diagnosis with angiography and intravascular ultrasound (IVUS). After the procedure, aspirin and clopidogrel were started as anticoagulant therapy. The hepatic arterial flow was well-maintained as shown by subsequent ultrasound and CT scans, and recurrence of the aneurysm was not seen. The patient was discharged POD 57 and is alive and well with no complications at 3 months after the operation.</p><p>【Conclusion】 Since the rupture of a hepatic artery pseudoaneurym is fatal, it is important to perform ultrasonography, CT scan, or magnetic resonance imaging periodically after transplantation to detect such a devastating complication early enough. As shown in the present case, a covered stent was considered to be effective in preventing a rupture.</p>