Eur. Radiol. 2, 330-334 (1992) © Springer-Verlag 1992 European Radiology Gastrointestinal radiology Arterial and pseudoaneurysm ruptures complicating liver transplantation H. Caiilet 1 , P. Cauquil 1 , Y. Ajavon 1 , G. Rouhana 1 , J. P. Verdier 1 , D. Azoulay 2, H. Bismuth 2 , and J. P. Tessier ~ Departments of 1Radiodiagnosis, and 2Surgery Paul Brousse Hospital, 12-14 av. Paul Vaillant Couturier B. R 200. 94804, VillejuifCedex, France immunosuppressive therapy, liver transplantation has become an accepted treatment for end-stage liver disease and for few primary liver tumors in both children and adults. The major complications of liver transplantation are rejection, biliary tract and vascular complications. The most common vascular complication is hepatic artery thrombosis [1, 2]. The occurence of thrombosis usually requires re transplantation because of severe graft failure, delayed biliary leak or intermittent episodes of sepsis [1-3]. Arterial ruptures (ARs) or pseudoaneurysm (PAs) ruptures are uncommon but life - threatening complica- tions following liver transplantation. The risk of a fatal hemorrage requires prompt diagnosis and surgery. Gener- ally these ruptures are a complication of infection [2] at the site of vascular anatomosis. The PA may also be the re- sult of arterial injury by a percutaneous biopsy or a biliary drainage [4, 5]. In this study we report the clinical, radio- logic and the findings evolution of seven acute vascular hemorrages following liver transplantation. Introduction The first human liver transplantation was performed in 1963. Since 1980, because of the success of cyclosporine as Correspondence to." H. Caillet Methods From 1983 through to December 1990, 640 liver trans- plantations were performed in our institution. During this period seven major arterial bleeding episodes occured postoperatively. Three were caused by an HA rupture and four by a PA rupture. Five of the seven patients died. All were men (mean age 39 years). Patients had been trans- planted for a variety of reasons. For four patients it was a first transplantation, for two a second and for one a third. The indications for re transplantation were rejection or a new viral hepatitis on the graft. Including of previous operations before transplantation, the patients had undergone an average of 3,3 operations mean. In all cases the transplantation was an orthotopic liver transplanta- tion (OLT) and in all cases but one allograft re arterialisa- tion was performed by end-to-end anastomosis between the donor celiac axis and the recipient common hepatic ar- tery. In the last liver, the re arterialisation was complex be- cause of the multiple arterial supply of the graft. Before