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Multifocal Visceral Artery Aneurysms Suggestive of Segmental Arterial Mediolysis after Living Donor Liver Transplantation: A Case Report

Year: 2026

Type: article

Abstract: INTRODUCTION: Segmental arterial mediolysis (SAM) is a rare, nonatherosclerotic, and noninflammatory arteriopathy that affects medium-sized visceral arteries and can cause life-threatening aneurysms. Multifocal non-anastomotic visceral artery aneurysms are unusual after liver transplantation and may indicate an underlying arteriopathy rather than a surgical complication. CASE PRESENTATION: A 63-year-old man underwent living donor liver transplantation for decompensated cirrhosis due to Wilson disease. Preoperative imaging showed two pre-existing splenic artery aneurysms, the larger of which (20 mm) was treated by coil embolization on POD 10. Follow-up CT on POD 15 unexpectedly revealed newly apparent multifocal aneurysms involving the hepatic, gastroduodenal, right gastroepiploic, superior mesenteric, and splenic arteries, sparing the hepatic arterial anastomosis. Infection, systemic vasculitis, and anastomotic pseudoaneurysm were carefully excluded, and the multifocal, non-anastomotic distribution was considered most compatible with SAM. The untreated lesions were managed conservatively. The early course was mixed, with thrombosis of some lesions coexisting with the appearance of new aneurysms, one of which was accompanied by an arterioportal fistula and was enlarged. No rupture or bleeding from the aneurysmal lesions occurred, and by 1 year, most lesions had thrombosed or regressed, with the patient remaining well. CONCLUSIONS: SAM should be considered when rapidly emerging, multifocal, non-anastomotic visceral artery aneurysms are encountered after liver transplantation. After careful exclusion of infection, vasculitis, and anastomotic complications, conservative management with close serial imaging may be considered in selected, hemodynamically stable patients without signs of rupture. Lesions with hemodynamic factors such as an arterioportal fistula may fail to thrombose and warrant particularly close surveillance.

Source: Surgical Case Reports

DOI: 10.70352/scrj.cr.26-0682