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Abstract
Hepatic artery complications can be divided into 2 different categories, nonocclusive and steno-occlusive disease. Steno-occlusive disease is a collective term that encompasses hepatic artery thrombosis, hepatic artery stenosis, and hepatic arterial kinks, while nonocclusive arterial disease encompasses less than 5% of complications and is a collective term used to describe arteriovenous fistulae, pseudoaneurysms, arterial rupture and nonocclusive hepatic artery hypoperfusion syndrome. This article details the angiographic techniques and definitions needed to accurately diagnose arterial transplant complications and describes the technical aspects and results of endoluminal management of these arterial complications. In addition, this article discusses the presentation, etiology and indications for treatment, including surgical management of these various complications.
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Affiliation(s)
- Ziga Cizman
- Department of Radiology and Imaging Sciences, University of Utah Hospital/Huntsman Cancer Institute, Salt Lake City, UT.
| | - Wael Saad
- Department of Radiology and Imaging Sciences, University of Utah Hospital/Huntsman Cancer Institute, Salt Lake City, UT
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2
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Semash KO, Dzhanbekov TA, Akbarov MM. Vascular complications after liver transplantation: contemporary approaches to detection and treatment. A literature review. RUSSIAN JOURNAL OF TRANSPLANTOLOGY AND ARTIFICIAL ORGANS 2023; 25:46-72. [DOI: 10.15825/1995-1191-2023-4-46-72] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Vascular complications (VCs) after liver transplantation (LT) are rare but are one of the most dreaded conditions that can potentially lead to graft loss and recipient death. This paper has analyzed the international experience in the early diagnosis of various VCs that can develop following LT, as well as the optimal timing and methods of treatment of these complications.
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Affiliation(s)
- K. O. Semash
- Republican Specialized Scientific and Practical Medical Center for Surgery; Tashkent Medical Academy
| | - T. A. Dzhanbekov
- Republican Specialized Scientific and Practical Medical Center for Surgery; Tashkent Medical Academy
| | - M. M. Akbarov
- Republican Specialized Scientific and Practical Medical Center for Surgery; Tashkent Medical Academy
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3
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Kubihal V, Sasturkar S, Mukund A. Imaging and Intervention in the Management of Vascular Complications Following Liver Transplantation. J Clin Exp Hepatol 2023; 13:854-868. [PMID: 37693256 PMCID: PMC10483010 DOI: 10.1016/j.jceh.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/27/2023] [Indexed: 09/12/2023] Open
Abstract
Liver transplantation is the treatment of choice in majority of the patients with end stage liver disease. Vascular complication following liver transplantation is seen in around 7-13% of the patients and is associated with graft dysfunction and high morbidity and mortality. Early diagnosis and prompt treatment are crucial in management of these patients. Advances in interventional radiology have significantly improved the management of vascular complications using minimally invasive percutaneous approach. Endovascular management is preferred in patients with late hepatic artery thrombosis, or stenosis, whereas retransplantation, surgical revision, or endovascular management can be considered in patients with early hepatic artery thrombosis or stenosis. Hepatic artery pseudoaneurysm, arterioportal fistula, and splenic artery steal syndrome are often treated by endovascular means. Endovascular management is also preferred in patients with symptomatic portal vein stenosis, early portal vein thrombosis, and symptomatic late portal vein thrombosis, whereas surgical revision or retransplantation is preferred in patients with perioperative portal vein thrombosis occurring within 3 days of transplantation. Venoplasty with or without stent placement can be considered in patients with hepatic venous outflow tract or inferior vena cava obstruction. Transjugular intrahepatic portosystemic shunt (TIPS) may be required in transplant recipients who develop cirrhosis, often, secondary to disease recurrence, or chronic rejection. Indications for TIPS remain same in the transplant patients; however, major difference is altered vascular anatomy, for which adjunct techniques may be required to create TIPS.
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Affiliation(s)
- Vijay Kubihal
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Shridhar Sasturkar
- Department of Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
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4
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Gheorghe G, Diaconu CC, Bungau S, Bacalbasa N, Motas N, Ionescu VA. Biliary and Vascular Complications after Liver Transplantation-From Diagnosis to Treatment. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:850. [PMID: 37241082 PMCID: PMC10221850 DOI: 10.3390/medicina59050850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
The last decades have brought impressive advances in liver transplantation. As a result, there was a notable rise in the number of liver transplants globally. Advances in surgical techniques, immunosuppressive therapies and radiologically guided treatments have led to an improvement in the prognosis of these patients. However, the risk of complications remains significant, and the management of liver transplant patients requires multidisciplinary teams. The most frequent and severe complications are biliary and vascular complications. Compared to vascular complications, biliary complications have higher incidence rates but a better prognosis. The early diagnosis and selection of the optimal treatment are crucial to avoid the loss of the graft and even the death of the patient. The development of minimally invasive techniques prevents surgical reinterventions with their associated risks. Liver retransplantation remains the last therapeutic solution for graft dysfunction, one of the main problems, in this case, being the low number of donors.
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Affiliation(s)
- Gina Gheorghe
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania; (G.G.); (N.B.); (V.-A.I.)
- Gastroenterology Department, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| | - Camelia Cristina Diaconu
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania; (G.G.); (N.B.); (V.-A.I.)
- Internal Medicine Department, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
| | - Nicolae Bacalbasa
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania; (G.G.); (N.B.); (V.-A.I.)
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania
| | - Natalia Motas
- Institute of Oncology “Profesor Doctor Alexandru Trestioreanu” Bucharest, 022328 Bucharest, Romania;
- Department of Thoracic Surgery, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania
| | - Vlad-Alexandru Ionescu
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania; (G.G.); (N.B.); (V.-A.I.)
- Gastroenterology Department, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
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5
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Gonzalez A, Cooper E, Herren J, Lipnik AJ, Xie KL. Diagnostic and Interventional Radiology in the Management of Post-Liver Transplant Vascular Complications. Semin Intervent Radiol 2022; 39:537-544. [PMID: 36561931 PMCID: PMC9767772 DOI: 10.1055/s-0042-1758113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Ana Gonzalez
- University of Illinois College of Medicine, Chicago, Illinois
| | - Eric Cooper
- University of Illinois College of Medicine, Chicago, Illinois
| | - Josi Herren
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Andrew J. Lipnik
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Karen L. Xie
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
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6
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Abdelaziz O, Osman AMA, Hosny KA, Emad-Eldin S, Serour DK, Mostafa M. Management of early hepatic artery thrombosis following living-donor liver transplantation: feasibility, efficacy and potential risks of endovascular therapy in the first 48 hours post-transplant-a retrospective cohort study. Transpl Int 2021; 34:1134-1149. [PMID: 33539596 DOI: 10.1111/tri.13839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/02/2020] [Accepted: 01/21/2021] [Indexed: 12/01/2022]
Abstract
This retrospective cohort study aims to review our 18-year experience with early hepatic artery thrombosis (e-HAT) following living-donor liver transplantation (LDLT), as well as to assess the feasibility, efficacy and potential risks of endovascular management of e-HAT in the first 48 hours (hrs) post-LDLT. Medical records of 730 patients who underwent LDLT were retrospectively reviewed. In all cases who had developed e-HAT, treatment modalities employed and their outcomes were evaluated. Thirty-one patients developed e-HAT(4.2%). Definite technical success and 1-year survival rates of surgical revascularization[11/31 cases(35.5%)] were 72.7% & 72.7%, whereas those of endovascular therapy[27/31 cases(87.1%)] were 70.4% & 59.3%, respectively. Endovascular therapy was carried out in the first 48hrs post-transplant in 9/31 cases(29%) [definite technical success:88.9%, 1-year survival:55.6%]. Four procedure-related complications were reported in 3 of those 9 cases(33.3%). In conclusion, post-LDLT e-HAT can be treated by surgical revascularization or endovascular therapy, with comparable results. Endovascular management of e-HAT in the first 48hrs post-LDLT appears to be feasible and effective, but is associated with a relatively higher risk of procedure-related complications, compared to surgical revascularization. Hence, it can be reserved as a second-line therapeutic option in certain situations where surgical revascularization is considered futile, potentially too complex, or potentially more risky.
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Affiliation(s)
- Omar Abdelaziz
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman M A Osman
- Department of General Surgery, Unit of Hepatobiliary Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Karim A Hosny
- Department of General Surgery, Unit of Vascular Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sally Emad-Eldin
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia K Serour
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Mostafa
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt
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7
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Ko GY, Sung KB, Gwon DI. The Application of Interventional Radiology in Living-Donor Liver Transplantation. Korean J Radiol 2021; 22:1110-1123. [PMID: 33739630 PMCID: PMC8236365 DOI: 10.3348/kjr.2020.0718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/05/2020] [Accepted: 11/14/2020] [Indexed: 01/10/2023] Open
Abstract
Owing to improvements in surgical techniques and medical care, living-donor liver transplantation has become an established treatment modality in patients with end-stage liver disease. However, various vascular or non-vascular complications may occur during or after transplantation. Herein, we review how interventional radiologic techniques can be used to treat these complications.
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Affiliation(s)
- Gi Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Kyu Bo Sung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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8
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Park J, Kim SH, Park S. Hepatic artery thrombosis following living donor liver transplantation: A 14‐year experience at a single center. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:548-554. [DOI: 10.1002/jhbp.771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/06/2020] [Accepted: 05/03/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Jangho Park
- Center for Liver & Pancreatobiliary Cancer National Cancer Center Goyang‐si Korea
| | - Seong Hoon Kim
- Center for Liver & Pancreatobiliary Cancer National Cancer Center Goyang‐si Korea
| | - Sang‐Jae Park
- Center for Liver & Pancreatobiliary Cancer National Cancer Center Goyang‐si Korea
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Devcic Z, Toskich BB, Livingston D, Croome KP, Lewis AR, Ritchie C, Frey G, McKinney JM, Paz-Fumagalli R. Endovascular Treatment of Aortohepatic Conduit Stenosis Following Liver Transplant. Transplant Proc 2020; 52:943-948. [PMID: 32139279 DOI: 10.1016/j.transproceed.2020.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/05/2019] [Accepted: 01/02/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Aortohepatic conduits (AHCs) are valuable alternatives when conventional hepatic artery anastomoses are not possible. However, AHCs have earlier and higher occlusion rates and reduced graft and patient survival. While endovascular therapy is safe and effective for conventional anastomotic stenoses, data on AHC stenoses are limited. This study reviewed outcomes for endovascular management of AHC stenosis at a single liver transplant center. METHODS A retrospective review of a prospectively maintained database was performed on the endovascular management of AHC stenosis between January 1, 2000, and December 31, 2016. Medical records, laboratory data, and imaging were analyzed for technical and hemodynamic success, primary and assisted primary patency, and patient and graft survival. RESULTS Seven patients underwent angioplasty a median of 142 days after transplant, and 2 required reintervention. The primary patency rate was 67% at 6 months and 22% at 1 year. The assisted primary patency rate was 83% at 6 months and 42% at 1, 3, and 5 years. Patient and graft survival were 86% at 6 months and 71%, 57%, and 38% at 1, 3, and 5 years, respectively. Four conduits were patent at last follow-up. There were no major adverse events after angioplasty. One reintervention was complicated by acute AHC thrombosis after stenting, causing biliary necrosis, sepsis, and death. There was no 30-day mortality, retransplant, or surgical revascularization because of endovascular intervention. CONCLUSIONS Endovascular treatment of AHC stenosis appears to be safe with a high technical success rate but lower long-term patency than standard hepatic arterial anastomoses.
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Affiliation(s)
- Zlatko Devcic
- Division of Vascular/Interventional Radiology, Mayo Clinic, Jacksonville, Florida, United States.
| | - Beau B Toskich
- Division of Vascular/Interventional Radiology, Mayo Clinic, Jacksonville, Florida, United States
| | | | - Kristopher P Croome
- Division of Transplant Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Andrew R Lewis
- Division of Vascular/Interventional Radiology, Mayo Clinic, Jacksonville, Florida, United States
| | - Charles Ritchie
- Division of Vascular/Interventional Radiology, Mayo Clinic, Jacksonville, Florida, United States
| | - Gregory Frey
- Division of Vascular/Interventional Radiology, Mayo Clinic, Jacksonville, Florida, United States
| | - J Mark McKinney
- Division of Vascular/Interventional Radiology, Mayo Clinic, Jacksonville, Florida, United States
| | - Ricardo Paz-Fumagalli
- Division of Vascular/Interventional Radiology, Mayo Clinic, Jacksonville, Florida, United States
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Thornburg B, Katariya N, Riaz A, Desai K, Hickey R, Lewandowski R, Salem R. Interventional radiology in the management of the liver transplant patient. Liver Transpl 2017; 23:1328-1341. [PMID: 28741309 DOI: 10.1002/lt.24828] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/26/2017] [Accepted: 07/03/2017] [Indexed: 02/06/2023]
Abstract
Liver transplantation (LT) is commonly used to treat patients with end-stage liver disease. The evolution of surgical techniques, endovascular methods, and medical care has led to a progressive decrease in posttransplant morbidity and mortality. Despite these improvements, a multidisciplinary approach to each patient remains essential as the early diagnosis and treatment of the complications of transplantation influence graft and patient survival. The critical role of interventional radiology in the collaborative approach to the care of the LT patient will be reviewed. Liver Transplantation 23 1328-1341 2017 AASLD.
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Affiliation(s)
- Bartley Thornburg
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Nitin Katariya
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Kush Desai
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Ryan Hickey
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Robert Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL.,Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL
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Zhang H, Qian S, Liu R, Yuan W, Wang JH. Interventional Treatment for Hepatic Artery Thrombosis after Liver Transplantation. J Vasc Interv Radiol 2017; 28:1116-1122. [DOI: 10.1016/j.jvir.2017.04.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 04/11/2017] [Accepted: 04/30/2017] [Indexed: 12/15/2022] Open
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Xue Z, Chen M, Zhang X, Wang G, He X, Wu L, Ma Y. Analysis of early hepatic artery thrombosis after liver transplantation. ANZ J Surg 2017; 88:172-176. [PMID: 28239947 DOI: 10.1111/ans.13911] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/25/2016] [Accepted: 12/19/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Zhicheng Xue
- Department of Organ Transplantation; The First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Maogen Chen
- Department of Organ Transplantation; The First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Xuzhi Zhang
- Department of Organ Transplantation; The First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Guodong Wang
- Department of Organ Transplantation; The First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Xiaoshun He
- Department of Organ Transplantation; The First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Linwei Wu
- Department of Organ Transplantation; The First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
| | - Yi Ma
- Department of Organ Transplantation; The First Affiliated Hospital of Sun Yat-Sen University; Guangzhou China
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13
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Feasibility and Midterm Results of Endovascular Treatment of Hepatic Artery Occlusion within 24 Hours after Living-Donor Liver Transplantation. J Vasc Interv Radiol 2017; 28:269-275. [DOI: 10.1016/j.jvir.2016.06.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/23/2016] [Accepted: 06/25/2016] [Indexed: 02/06/2023] Open
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McIlveen E, Jackson A, Bowie J, Stirling C, Downie A, Kingsmore D. A unique case of acute embolus in a renal transplant with salvage by catheter-directed thrombolysis. Scott Med J 2016; 61:106-110. [PMID: 27543329 DOI: 10.1177/0036933016635402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Acute renal transplant emboli can be disastrous and result in loss of the renal transplant. This case was successfully treated with thrombolysis. CASE PRESENTATION A 66-year-old female underwent a right-sided deceased heart-beating donor renal transplant. She had excellent transplant function but presented acutely three years later with pain in the transplanted kidney, an acute rise in serum creatinine and new onset atrial fibrillation. Bedside ultrasound scan demonstrated absent transplant perfusion. Emergency angiogram confirmed acute emboli in the transplant renal artery with some kidney perfusion. Thrombolysis with alteplase and anticoagulation with heparin was commenced. Serial imaging at 24 and 36 h demonstrated significant improvement in transplant perfusion. Following a period of supportive therapy, her transplant function recovered, although not to pre-morbid baseline levels. CONCLUSION Consider acute embolus in a renal transplant patient with acute kidney injury, transplant tenderness and cardiac arrhythmia. Early thrombolysis may salvage renal transplants and good transplant function may be regained.
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Affiliation(s)
- E McIlveen
- LAT Specialty Trainee 3, West of Scotland Deanery, UK
| | - A Jackson
- Specialty Trainee 7, West of Scotland Deanery, UK
| | - J Bowie
- GPST1, West of Scotland Deanery, UK
| | - C Stirling
- Consultant Nephrologist, Western Infirmary, UK
| | - A Downie
- Consultant Radiologist, Western Infirmary, UK
| | - D Kingsmore
- Consultant Vascular and Transplant Surgeon, Western Infirmary, UK
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15
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Luo MY, Wu YJ, Lin TC, Shen TY, Yang HP, Chen CC, Chen FC. Percutaneous Transluminal Angioplasty and Stenting for Hepatic Vessel Stenosis after Orthotopic Liver Transplantation. ACTA CARDIOLOGICA SINICA 2016; 31:152-7. [PMID: 27122863 DOI: 10.6515/acs20140503a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study aimed to evaluate the efficacy of vascular intervention in percutaneous transluminal angioplasty (PTA) for the treatment of hepatic artery and hepatic vein stenosis after liver transplantation (LT), including thrombotic total occluded lesions. METHODS Percutaneous transluminal angioplasty after orthotopic liver transplantation was performed to re-open hepatic vessel lesions. We daily used routine Doppler ultrasound during admission for early detection of graft hepatic vessel lesions, including hepatic artery and vein lesions. In outpatients, Doppler ultrasound was performed every month. Urokinase was delivered with a dose of 150,000-300,000 IU by catheter before PTA for thrombotic total occlusion of the graft for hepatic artery patients. Laboratory data were collected to evaluate the effects of the PTA procedure. RESULTS The study involved a total of seven patients, six of whom were successfully treated by a first PTA procedure. Thrombolysis use of urokinase in totally occluded donor hepatic arteries post-LT following stenting was successful in three patients. One complication occurred, an arterial dissection and perforation, finalizing the success rate at ~86% and the complication rate at ~14%. Therefore, our study has a primary patency rate of 100% at 1 and 3 months. Also, the graft survival rate was 100 % and 86 % in the first and third months, respectively. CONCLUSIONS PTA with stenting is an effective treatment for hepatic vessel stenosis, including hepatic arteries and hepatic veins, after a liver transplantation without an increase in the complication rate. In addition, thrombolysis using urokinase intra-artery infusion in graft thrombotic total occluded patients is a good treatment strategy as well. KEY WORDS Angioplasty; Complication; Liver transplantation.
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Affiliation(s)
- Ming-Yuan Luo
- Division of Cardiovascular Center, Department of Medicine
| | - Yi-Ju Wu
- Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Tung-Chao Lin
- Division of Cardiovascular Center, Department of Medicine
| | - Thau-Yun Shen
- Division of Cardiovascular Center, Department of Medicine
| | - Ho-Pang Yang
- Division of Cardiovascular Center, Department of Medicine
| | | | - Fu-Chung Chen
- Division of Cardiovascular Center, Department of Medicine
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16
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Le L, Terral W, Zea N, Bazan HA, Smith TA, Loss GE, Bluth E, Sternbergh WC. Primary stent placement for hepatic artery stenosis after liver transplantation. J Vasc Surg 2015; 62:704-9. [PMID: 26054583 DOI: 10.1016/j.jvs.2015.04.400] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/19/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Significant hepatic artery stenosis (HAS) after orthotopic liver transplantation (OLT) can lead to thrombosis, with subsequent liver failure in 30% of patients. Although operative intervention or retransplantation has been the traditional solution, endovascular therapy has emerged as a less invasive treatment strategy. Prior smaller studies have been conflicting in the relative efficacy of percutaneous transluminal angioplasty (PTA) vs primary stent placement for HAS. METHODS This was a single-center retrospective review of all endovascular interventions for HAS after OLT during a 54-month period (August 2009-December 2013). Patients with ultrasound imaging with evidence of severe HAS (peak systolic velocity >400-450 cm/s, resistive index <0.5) underwent endovascular treatment with primary stent placement or PTA. Outcomes calculated were technical success, primary and primary assisted patency rates, reinterventions, and complications. RESULTS Sixty-two interventions for HAS were performed in 42 patients with a mean follow-up of 19.1 ± 15.2 months. During the study period, 654 OLTs were performed. Of 61 patients diagnosed with HAS, 42 underwent an endovascular intervention. The rate of endovascularly treated HAS was 6.4% (42 of 654). Primary technical success was achieved in 95% (59 of 62) of the interventions. Initial treatment was with PTA alone in 17 or primary stent in 25. Primary patency rates after initial stent placement were 87%, 76.5%, 78%, and 78% at 1, 6, 12, and 24 months, respectively, compared with initial PTA rates of 64.7%, 53.3%, 40%, and 0% (P = .19). There were 20 reinterventions in 14 patients (eight stents, six PTAs). The time to the initial reintervention was 51 days in patients with PTA alone vs 105.8 days for those with an initial stent (P = .16). Overall primary assisted patency was 93% at 24 months. Major complications were one arterial rupture and two hepatic artery dissections. The long-term risk of hepatic artery thrombosis in the entire patient cohort was 3.2%. CONCLUSIONS HAS after OLT can be treated endovascularly with high technical success and excellent primary assisted patency. This series represents the largest reported cohort of endovascular interventions for HAS to date. Initial use of a stent showed a strong trend toward decreasing the need for reintervention. Avoidance of hepatic artery thrombosis is possible in >95% of patients with endovascular treatment and close follow-up.
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Affiliation(s)
- Linda Le
- Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La
| | - William Terral
- Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La
| | - Nicolas Zea
- Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La
| | - Hernan A Bazan
- Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La
| | - Taylor A Smith
- Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La
| | - George E Loss
- Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La
| | - Edward Bluth
- Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La
| | - W Charles Sternbergh
- Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La.
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Copelan A, George D, Kapoor B, Nghiem HV, Lorenz JM, Erly B, Wang W. Iatrogenic-related transplant injuries: the role of the interventional radiologist. Semin Intervent Radiol 2015; 32:133-55. [PMID: 26038621 DOI: 10.1055/s-0035-1549842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As advances in surgical techniques and postoperative care continue to improve outcomes, the use of solid organ transplants as a treatment for end-stage organ disease is increasing. With the growing population of transplant patients, there is an increasing need for radiologic diagnosis and minimally invasive procedures for the management of posttransplant complications. Typical complications may be vascular or nonvascular. Vascular complications include arterial stenosis, graft thrombosis, and development of fistulae. Common nonvascular complications consist of leaks, abscess formation, and stricture development. The use of interventional radiology in the management of these problems has led to better graft survival and lower patient morbidity and mortality. An understanding of surgical techniques, postoperative anatomy, radiologic findings, and management options for complications is critical for proficient management of complex transplant cases. This article reviews these factors for kidney, liver, pancreas, islet cell, lung, and small bowel transplants.
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Affiliation(s)
- Alexander Copelan
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Daniel George
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Baljendra Kapoor
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hahn Vu Nghiem
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Jonathan M Lorenz
- Section of Interventional Radiology, The University of Chicago, Chicago, Illinois
| | - Brian Erly
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio ; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Weiping Wang
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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18
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Clinical Outcome of Idiopathic Hepatic Parenchymal Infarct Following Living Donor Liver Transplantation. Transplant Proc 2013; 45:3072-5. [DOI: 10.1016/j.transproceed.2013.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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19
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Abdelaziz O, Hosny K, Amin A, Emadeldin S, Uemoto S, Mostafa M. Endovascular management of early hepatic artery thrombosis after living donor liver transplantation. Transpl Int 2012; 25:847-56. [PMID: 22708507 DOI: 10.1111/j.1432-2277.2012.01509.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To study the feasibility of endovascular management of early hepatic artery thrombosis (HAT) after living-donor liver transplantation (LDLT) and to clarify its role as a less invasive alternative to open surgery. A retrospective review of 360 recipients who underwent LDLT. Early HAT developed in 13 cases (3.6%). Diagnosis was performed using Doppler, CT angiography, and digital subtraction angiography. Intra-arterial thrombolysis (IAT) was performed using streptokinase or tPA. In case of underlying stricture, PTA was attempted. If the artery did not recanalize, continuous infusion was performed and monitored using Doppler US. Initial surgical revascularization was successful in 2/13 cases. IAT was performed in 11/13 cases. The initial success rate was 81.8% (9/11), the failure rate was 18.2% (2/11). Rebound thrombosis developed in 33.3% (3/9). Hemorrhage developed after IAT in 2/11 cases (18.2%). Definite endovascular treatment of HAT was achieved in 6/11 cases (54.5%) and definite treatment (surgical, endovascular or combined) in 9/13 cases (69%). (Follow-up 4 months-4 years). Endovascular management of early HAT after LDLT is a feasible and reliable alternative to open surgery. It plays a role as a less invasive approach with definite endovascular treatment rate of 54.5%.
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Affiliation(s)
- Omar Abdelaziz
- Diagnostic and Intervention Radiology Department, Cairo University Hospitals, Cairo, Egypt.
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20
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Saad WEA, Dasgupta N, Lippert AJ, Turba UC, Davies MG, Kumer S, Gardenier JC, Sabri SS, Park AW, Waldman DL, Schmitt T, Matsumoto AH, Angle JF. Extrahepatic Pseudoaneurysms and Ruptures of the Hepatic Artery in Liver Transplant Recipients: Endovascular Management and a New Iatrogenic Etiology. Cardiovasc Intervent Radiol 2012; 36:118-27. [DOI: 10.1007/s00270-012-0408-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 04/08/2012] [Indexed: 02/07/2023]
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21
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Saad WEA, Darwish WE, Turba UC, Angle JF, Wagner CE, Matsumoto AH, Brayman K, Hagspiel KD. Endovascular management of vascular complications in pancreatic transplants. Vasc Endovascular Surg 2012; 46:262-8. [PMID: 22492112 DOI: 10.1177/1538574412438949] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Vascular complications after pancreatic transplantation carry a high rate of graft loss. Endovascular management of these complications is confined to stent placement for iliac artery inflow disease and embolization for arteriovenous fistulae (AVFs), pseudoaneurysms, or active bleeding. The current study describes the endovascular management of pancreatic transplant venous thrombosis (N = 1), arterial stenosis (N = 5), thrombosis (N = 3), pseudoaneurysms (N = 1), and AVF (N = 2). In addition, embolization of nonfunctioning grafts is described as an endovascular alternative to pancreatectomy.
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Affiliation(s)
- Wael E A Saad
- Department of Radiology & Medical Imaging, Division of Vascular Interventional Radiology, University of Virginia Health System, Charlottesville, VA 22908, USA.
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22
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Oliveira FMD, Mourão GDS. Angioplastia subintimal após trombose tardia de stent implantado em artéria hepática de fígado transplantado. J Vasc Bras 2012. [DOI: 10.1590/s1677-54492012000100009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Os autores relatam um caso de estenose de artéria hepática transplantada tratada com angioplastia e stent, que evoluiu para trombose completa após 30 dias do procedimento. Realizada trombólise intra-arterial e angioplastia subintimal com sucesso. Controle angiotomográfico após 90 dias demonstra perviedade da artéria hepática.
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23
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Lee JH, Oh DY, Seo JW, Moon SH, Rhie JW, Ahn ST. Versatility of right gastroepiploic and gastroduodenal arteries for arterial reconstruction in adult living donor liver transplantation. Transplant Proc 2011; 43:1716-9. [PMID: 21693264 DOI: 10.1016/j.transproceed.2011.03.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 02/23/2011] [Accepted: 03/09/2011] [Indexed: 01/01/2023]
Abstract
BACKGROUND In cases where there is severe intimal dissection in the recipient hepatic artery (HA), or if the HA has been used already and additional operations are needed due to graft rejection or arterial occlusion, an alternative is necessary. In the present study, we have reported the feasibility of using the right gastroepiploic artery (RGEA) and gastroduodenal artery (GDA) in various situations where the HA is not a feasible option. METHODS Among 463 patients who underwent primary adult-to-adult living donor liver transplantation from January 2002 to July 2010, eight subjects required alternative vessels. Four recipients displayed severe intimal injury associated with previous transarterial chemoembolization (TACE); two, required a salvage operation due to hepatic artery thrombosis (HAT); and two, retransplantations due to chronic rejection. The RGEA was used in five and the GDA in three patients. RESULTS Postoperative Doppler ultrasonography and three-dimensional computed tomography showed patent arterial flow in all patients. However, HAT recurred in one patient who underwent a salvage operation with the RGEA; she died 2 months later. Two other patients died due to wound infection and respiratory failure within 3 months despite intact hepatic arterial flow. Four patients had no further complications during follow-up (mean = 33 months). CONCLUSION Although there was a discrepancy in the diameter of the HA and the RGEA (or GDA), there was no problem with mobilization and microanastomosis. We therefore believe that these vessels can be good alternatives when the hepatic artery is unavailable.
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Affiliation(s)
- J H Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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24
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Sabri SS, Saad WEA, Schmitt TM, Turba UC, Kumer SC, Park AW, Matsumoto AH, Angle JF. Endovascular therapy for hepatic artery stenosis and thrombosis following liver transplantation. Vasc Endovascular Surg 2011; 45:447-52. [PMID: 21571780 DOI: 10.1177/1538574411407088] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the effectiveness of endovascular management of steno-oclusive disease in liver transplants. METHODS Retrospective review of liver transplant recipients with hepatic artery stenosis (HAS) or thrombosis (HAT) was performed. The HAS group was treated with balloon angioplasty with selective stent placement. The HAT group was treated with catheter-directed thrombolysis. Primary, unassisted, and assisted patency and graft survival rates were calculated. RESULTS In all, 31 patients were identified (21 males; mean age, 51 years). A total of 25 of 31 (81%) patients had HAS and 6 of 31 (19%) had HAT. Collectively, a total of 35 endovascular procedures were performed to treat HAS in 25 patients. Overall technical success rate was 91%, with 11% major complication rate. Primary-assisted patency rate and graft survival at 6 and 12 months were 87% and 81%, and 76% and 72%, respectively. Only 1 successful thrombolysis of HAT was achieved. CONCLUSION Endovascular management is effective for HAS but not for HAT.
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Affiliation(s)
- Saher S Sabri
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Virginia Health System, Charlottesville, VA, USA
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25
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Management of Early Hepatic Arterial Thrombosis After Pediatric Living-Donor Liver Transplantation. Transplant Proc 2011; 43:605-8. [DOI: 10.1016/j.transproceed.2011.01.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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26
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Singhal A, Mukherjee I, Stokes K, Wright HI, Sebastian A, Kohli V. Continuous Intraarterial Thrombolysis for Early Hepatic Artery Thrombosis Following Liver Transplantation: Case Report. Vasc Endovascular Surg 2009; 44:134-8. [DOI: 10.1177/1538574409348353] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Hepatic Artery thrombosis remains one of the major causes of graft failure and mortality in liver transplant recipients. Urgent re-transplantation has been considered as mainstay therapy; however, even with re-transplantation mortality of more than 50% has been reported by many series. Early detection on Doppler ultrasonography and subsequent revascularization in asymptomatic patients can avoid graft loss. Endovascular therapy including intra-arterial thrombolysis, percutaneous transluminal angioplasty, and stent placement have shown encouraging results in recent years; nevertheless, their use remains controversial due to potential risk of bleeding. We present a case of early hepatic artery thrombosis following liver transplantation treated successfully with continuous transcatheter intra-arterial thrombolysis using tissue plasminogen activator (t-PA).
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Affiliation(s)
- Ashish Singhal
- Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
| | - Indraneil Mukherjee
- Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
| | - Kenneth Stokes
- Department of Interventional Radiology, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
| | - Harlan I. Wright
- Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
| | - Anthony Sebastian
- Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
| | - Vivek Kohli
- Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma,
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27
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Singhal A, Stokes K, Sebastian A, Wright HI, Kohli V. Endovascular treatment of hepatic artery thrombosis following liver transplantation. Transpl Int 2009; 23:245-56. [PMID: 20030796 DOI: 10.1111/j.1432-2277.2009.01037.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatic artery thrombosis (HAT) is the most frequent vascular complication following orthotopic liver transplantation. Urgent retransplantation has been considered as the mainstay therapy. Surgical revascularization is an effective alternative in asymptomatic patients. Endovascular therapies including intra-arterial thrombolysis, percutaneous transluminal angioplasty (PTA), and stent placement have shown encouraging results in recent years; however, their use remains controversial because of potential risk of hemorrhage. Until June 2009, 69 cases were published in 16 reports describing therapeutic potential of endovascular modalities. Interventions were performed as early as within 4 h to as late as 120 days in patients ranging from 4 months to 64 years of age. Majority of published reports suggested the use of urokinase. Thrombolysis was successful in 47 out of 69 (68%) patients. Bleeding was the most common complication including fatal intra-abdominal hemorrhage in three patients. Twenty-nine out of 47 (62%) patients underwent further intervention in the form of PTA, stenting, or both. The follow-up patency ranged from 1 month to 26 months. In conclusion, whenever possible, efforts should be made to rescue the liver grafts through urgent revascularization (surgical and/or endovascular) depending on patient's condition and interventional expertise at the transplant center; reserving the option of retransplantation for failure, complications, and cases with severe clinical symptoms or allograft dysfunction.
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Affiliation(s)
- Ashish Singhal
- Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, Oklahoma City, OK 73112, USA
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28
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Miraglia R, Maruzzelli L, Caruso S, Milazzo M, Marrone G, Mamone G, Carollo V, Gruttadauria S, Luca A, Gridelli B. Interventional radiology procedures in adult patients who underwent liver transplantation. World J Gastroenterol 2009; 15:684-93. [PMID: 19222091 PMCID: PMC2653436 DOI: 10.3748/wjg.15.684] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Interventional radiology has acquired a key role in every liver transplantation (LT) program by treating the majority of vascular and non-vascular post-transplant complications, improving graft and patient survival and avoiding, in the majority of cases, surgical revision and/or re-transplantation. The aim of this paper is to review indications, technical consideration, results achievable and potential complications of interventional radiology procedures after deceased donor LT and living related adult LT.
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29
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Sotiropoulos GC, Treckmann J, Fouzas I, Molmenti EP, Nowak KM, Broelsch CE, Paul A, Lang H. Eurotransplant special request for high-urgency status after liver transplantation for hepatocellular carcinoma: a case report. Transplant Proc 2008; 40:3211-2. [PMID: 19010237 DOI: 10.1016/j.transproceed.2008.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hepatic artery thrombosis after liver transplantation remains a major indication for retransplantation. We report the case of a 49-year-old man with a hepatocellular carcinoma in the setting of cirrhosis associated with chronic hepatitis B and C infections who underwent split liver transplantation. The patient experienced a complicated postoperative course, characterized by 2 relaparotomies for necrosis of segment IV, and a late hepatic artery thrombosis, first discovered on postoperative day 20. His subsequent course was characterized by relapsing cholangitis and liver abscesses requiring antibiotics and percutaneous drainage. Transient control of the septic complications allowed for the filing of a special high-urgency status request that was approved by Eurotransplant. The patient underwent retransplantation 1 week later with a full-size deceased donor graft. He is currently alive, well, with no evidence of tumor recurrence at 30 months posttransplantation. The existence of exceptions within the system, such as the "special high-urgency status" of Eurotransplant, as well as the aggressive treatment of complications to obtain a "window of clinical opportunity" saved this patient's life.
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Affiliation(s)
- G C Sotiropoulos
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Essen, Germany; Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany.
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30
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López-Benítez R, Schlieter M, Hallscheidt PJ, Radeleff BA, Kauffmann G, Richter GM, Schmidt J, Engelmann G. Successful arterial thrombolysis and percutaneous transluminal angioplasty for early hepatic artery thrombosis after split liver transplantation in a four-month-old baby. Pediatr Transplant 2008; 12:606-10. [PMID: 18652621 DOI: 10.1111/j.1399-3046.2008.00925.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Early HAT is the most frequent and severe vascular complication following liver transplantation. It is one of the major causes of graft failure and mortality. Endovascular thrombolytic treatment in patients with thrombotic complications after liver transplantation is an attractive alternative to open surgery as lower morbidity and mortality rates are reported for it. PTA following transcatheter thrombolysis has been successfully used to treat HAT in adults. To the best of our knowledge, there have not been any reports of a successful transcatheter thrombolysis using interventional radiological techniques in a patient only four months old. The present report describes the successful endovascular emergency treatment of a HAT three days after DD split liver transplantation.
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Affiliation(s)
- R López-Benítez
- Department of Diagnostic Radiology, University of Heidelberg, Heidelberg, Germany.
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31
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Boyvat F, Aytekin C, Harman A, Sevmiş S, Karakayali H, Haberal M. Endovascular stent placement in patients with hepatic artery stenoses or thromboses after liver transplant. Transplant Proc 2008; 40:22-6. [PMID: 18261538 DOI: 10.1016/j.transproceed.2007.12.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatic artery stenosis or thrombosis following liver transplant is a potentially life-threatening complication. Successful liver transplant depends on uncompromised hepatic arterial inflow. Early diagnosis and treatment of complications prolong graft survival. Interventional radiologic techniques are frequently used to treat hepatic artery complications. Twenty patients with hepatic artery stenoses (n = 11) or thromboses (n = 9) were included in this study. Eighteen of the 20 patients were successfully treated by stent placement. In 9 patients, early endovascular interventions were performed 1 to 7 days after surgery. Two patients were operated owing to the effects of dissection and bleeding from the hepatic artery. Repeat endovascular interventions were performed 10 times in 6 patients. Follow-up ranged from 5 months to 4.5 years. Nine patients with patent hepatic arteries died during follow-up owing to reasons unrelated to the hepatic artery interventions. In 3 patients, the stents became occluded at 3, 5, and 9 months after surgery but no clinical symptoms were present.
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Affiliation(s)
- F Boyvat
- Department of Radiology, Başkent University Medical Faculty, Ankara, Turkey
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32
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Stent-Graft for the Management of Hepatic Artery Rupture Subsequent to Transcatheter Thrombolysis and Angioplasty in a Liver Transplant Recipient. Cardiovasc Intervent Radiol 2007; 31 Suppl 2:S104-7. [DOI: 10.1007/s00270-007-9188-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Revised: 09/09/2007] [Accepted: 09/13/2007] [Indexed: 10/22/2022]
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33
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Saad WE. Management of Hepatic Artery Steno-Occlusive Complications After Liver Transplantation. Tech Vasc Interv Radiol 2007; 10:207-20. [PMID: 18086426 DOI: 10.1053/j.tvir.2007.09.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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