The role of interventional radiology in the management of early vascular complications after liver transplantation
Behlul Igus1, Fatih Boyvat1, Aydincan Akdur2, Ozgur Ozen1, Ebru H. Ayvazoglu Soy2, Mehmet Haberal2.
1Department of Radiology , Baskent University, Ankara, Turkey; 2Department of General Surgery, Division of Transplantation, Baskent University, Ankara, Turkey
Introduction: Hepatic vascular complications after liver transplantation (LT) is a serious condition, which often results in graft failure and can lead to patient deaths. Early diagnosis and treatment of vascular complications provide prolong graft survival, and prohibited further complications. This study presents our experience of using endovascular treatments during the first week after liver transplant.
Method: 238 liver transplantations were performed in a single center between 2012 and 2021. In 59 patients out of 238 liver transplant patients (37 men; mean age 27 ± 2.9 years); early endovascular interventions were carried 1 to 7 days (mean 2,7day ±0,24) after surgery. Doppler ultrasound was used in all cases, and computed tomography angiography was used in needed cases. Patients with vascular complications were grouped by arterial, venous, portal, and bleeding complication. In addition, arterial complications were sub grouped by occlusive (Hepatic artery thrombosis (HAT)) and non-occlusive (Hepatic artery stenosis (HS) /Splenic Artery Steal Syndrome (SAS)). The median follow-up period was 47± 4 month (range: 1 to 96 month).
Result: Seven patients had an arterial complication which was consisted of 5 HAT and 2 HAS. Five patients with hepatic artery thrombosis, intra-arterial thrombolysis was performed through the catheter. In two patients, continuous thrombolysis was performed to lyse the thrombus. The percutaneous transluminal angioplasty (PTA) was performed in all patients. Two of five HAT patients, stents were placed after the insufficient PTA. Two of these patients developed new stenosis and treated with repeat PTA.
Thirty-six patient’s diagnosis with SAS were treated by selective arterial embolization with coil devices. Angiographically, all SAS cases have demonstrated an increase in the hepatic arterial caliper and parenchymal perfusion after the treatment.
Five patients had been diagnosed with hepatic venous outflow obstruction. Two of the five patients were treated with balloon angioplasty, and three of them stents were used for insufficient flow after the balloon angioplasty.
In four patients, active bleeding was embolized by endovascular intervention with coils or glue. No rebleeding was observed on follow-up.
One patient with portal vein stenosis was observed after the LT and was treated with stent insertion.
During the follow-up period, the patient survival rate was 76, 3% (45/59).
Conclusion: Early endovascular intervention is feasible and safe in hepatic vascular complications following liver transplantation and also achieves a high success rate with the advance in interventional radiology.
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