Abstract Update

The following abstract has been replaced:
Abstract 188: Gastrointestinal: Potpourri.
Author: G. Schueller.
Title: Multi-detector row CT of the pancreas: effects of contrast material flow rates and individualized scan delay on enhancement of the pancreas and tumor contrast.

NEW 188: Endovascular management of arterial complications after small bowel and multivisceral transplantation
Amesur N.B.¹; Zajko A.B.¹; Bond G.J.²; Abu-Elmagd K.².1. University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA; 2.University of Pittsburgh Medical Center, Department of Surgery, Pittsburgh, PA.

Objective: Small bowel transplant (SBTx) and multi-visceral transplant (MVTx) are standard of care for irreversible intestinal failure. Vascular complications are life threatening and difficult to manage surgically because of the technical complexity of the arterial reconstruction and post transplant adhesions. This report highlights diagnostic and therapeutic approaches for three major vascular events that required prompt intervention.
Materials and Methods: During SBTx & MVTx, an infrarenal aortic graft is placed for restoration of arterial inflow and anastomosed to the superior mesenteric artery (SMA) of the intestine and common arterial conduit of the MVTx graft. This report describes three recipients who developed arterial complications 6 months to 3 years after SBTx (n=1) and MVTx (n=2). Two patients had a hypercoaguable state requiring anticoagulation. All three patients presented with acute abdominal pain.
Results: Emergent enhanced abdominal computed tomography was performed and was diagnostic in 2 patients with aortic leak (n=1) and non-occlusive thrombus (n=1). Immediate arteriography demonstrated: active bleeding from the anastomotic pseudoaneurysm (PA)(MVTx); and non-occlusive thrombus in the SMA of the intestine (SBTx) and anastomotic arterial conduit of the second MVTx. The PA had a wide neck and was adjacent to the origin of the arterial branches, precluding percutaneous embolization. Accordingly, a combined approach of endovascular intervention and surgical repair was pursued. A 18mm diameter balloon catheter was placed in the infrarenal aortic graft proximal to the PA and utilized for temporary occlusion of arterial inflow during surgical repair. The 2 patients with non-occlusive thrombus were successfully treated with percutaneous intra-arterial thrombolysis and balloon angioplasty. However, the SBTx recipient developed a tiny perforation of the distal ileum that required surgical intervention. There were no further complications related to the vascular insult or intervention. With a median follow-up of 16 months, all three patients are currently alive with fully functioning grafts.
Conclusions: Endovascular intervention is a crucial and valuable tool for successful management of different vascular complications after SBTx and MVTx.