Pseudoaneurysms of the intrahepatic arterial branches are a well-known complication after interventional biliary procedures (Tessier et al. 2003). In adults, treatment options depend on the pseudoaneurysms’ location, configuration, and size and include endovascular embolization, stent placement, or surgical ligation (St Michel et al. 2019). To date, a single description was published of percutaneous transhepatic coil embolization in an adult with the pseudoaneurysm measuring 1.5 cm (Millonig et al. 2004). However, very little is known about treatment of small arterial pseudoaneurysms in infants after split-liver transplantation.
Because of the very small diameter of segmental arteries and the pseudoaneurysms, as well as localization and configuration of pseudoaneurysms in pediatric split-liver transplants, surgery, stent placement, endovascular coiling of the aneurysm, and embolization of the segmental artery may be associated with an unfavorable risk-benefit profile resulting in loss of arterial perfusion and high morbidity. Ultrasound-guided thrombin injection has been reported as a treatment option for the occlusion of a pseudoaneurysm after liver laceration in an infant. However, this technique failed to occlude the aneurysm permanently in our case (Lorenz et al. 2013).
Direct percutaneous access and highly selective, exclusive embolization of the aneurysm prevents complications related to open surgery and even related to endovascular approaches.
We favored CEUS for follow-up since this technique is able to generate real time imaging without sedation and radiation exposure. Moreover, this technique has already proved to be a safe imaging technique in children after liver transplantation (Torres et al. 2019) and in the detection of pseudoaneurysms (Durkin et al. 2016).