Flow Diverting Stents (FDS) for Treatment of Hepatic Artery Pseudoaneurysm (HAP) After Orthotopic Liver Transplantation (OLT)

Background: Hepatic artery pseudoaneurysm (HAP) is uncommon after orthotopic liver transplantation (OLT). No ideal endovascular technique has been defined for treatment. Small diameter "Flow diverting stents" (FDS) are indicated for intra-cranial applications and are designed to maintain laminar flow in the vessel lumen whilst promoting thrombosis of the aneurysm sack. Due to their low profile, FDS may be ideal for this novel application.

Purpose: To report the "off-label" use of a flow diverting stent (FDS) to treat a large HAP after OLT with short term follow up.

Materials and Methods: A 62-year-old patient had an incidentally discovered HAP two years after OLT. Digital subtraction angiography confirmed the CECT finding of a 1.5 cm HAP arising from a very tortuous hepatic artery with marked variation in proximal (4mm) and distal (6mm) vessel diameters. Using a microcatheter an FDS was successfully deployed, resulting in aneurysm exclusion with preserved hepatic artery patency. The patient received DAP therapy.

Results: At 3-month follow up, the HAP was excluded, with slight reduction in size, together with preservation of normal hepatic arterial flow and duplex examination.

Conclusion: FDS appear to be promising in the management of HAP after OLT. Long term follow-up is mandatory.