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Peer-reviewedCC BY 4.0Surgical Case Reports

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

  • Shunsuke Shichi1
  • Tatsuhiko Kakisaka1
  • Akihisa Nagatsu1
  • Yuzuru Sakamoto1
  • Sunao Fujiyoshi1
  • Takeshi Aiyama1
  • Norio Kawamura1
  • Masaaki Watanabe1
  • Ryoichi Goto1
  • Naoya Kinota2
  • Ryo Morita2
  • Daisuke Abo2
1 more authors
  • Akinobu Taketomi1
  1. 1Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
  2. 2Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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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.

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Cite

BibTeXRIS
BibTeX
@article{shichi2026multifocal,
  title = {{Multifocal Visceral Artery Aneurysms Suggestive of Segmental Arterial Mediolysis after Living Donor Liver Transplantation: A Case Report}},
  author = {Shunsuke Shichi and Tatsuhiko Kakisaka and Akihisa Nagatsu and Yuzuru Sakamoto and Sunao Fujiyoshi and Takeshi Aiyama and Norio Kawamura and Masaaki Watanabe and Ryoichi Goto and Naoya Kinota and Ryo Morita and Daisuke Abo and Akinobu Taketomi},
  journal = {Surgical Case Reports},
  year = {2026},
  month = nov,
  doi = {10.70352/scrj.cr.26-0682},
  url = {https://doi.org/10.70352/scrj.cr.26-0682},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Multifocal Visceral Artery Aneurysms Suggestive of Segmental Arterial Mediolysis after Living Donor Liver Transplantation: A Case Report
AU  - Shunsuke Shichi
AU  - Tatsuhiko Kakisaka
AU  - Akihisa Nagatsu
AU  - Yuzuru Sakamoto
AU  - Sunao Fujiyoshi
AU  - Takeshi Aiyama
AU  - Norio Kawamura
AU  - Masaaki Watanabe
AU  - Ryoichi Goto
AU  - Naoya Kinota
AU  - Ryo Morita
AU  - Daisuke Abo
AU  - Akinobu Taketomi
PY  - 2026
DA  - 2026/11/03
JO  - Surgical Case Reports
DO  - 10.70352/scrj.cr.26-0682
UR  - https://doi.org/10.70352/scrj.cr.26-0682
AB  - 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.
SN  - 2198-7793
ER  -