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Abstract

Objectives: Hepatic artery thrombosis remains a major complication after orthoptic liver transplant. Treatment of hepatic artery thrombosis is complex and requires a multidisciplinary approach. Retransplant is the procedure of choice. In nonsurgical candidates, endovascular options are evolving. Materials and Methods: Based on our experience at a busy transplant center, we discuss 4 representative cases to explain the potential role of endovascular treatment beyond just attempts at recanalization. From our experience, as well as a review of the literature, we propose a clinical practice algorithm for optimal treatment of hepatic artery thrombosis after orthoptic liver transplant. Results: The primary traditional endovascular interventional options remain thrombectomy, balloon angioplasty, and use of stents with the aim of revascularization. However, these methods have not proven to be effective. Ultrasonography-assisted thrombolysis, which has thus far been relatively less described in the hepatic vasculature, has the potential of producing the same angiographic results but at lower doses of the thrombolytic agent, thus decreasing the potential for hemorrhagic complications. The adjunctive use of splenic artery embolization and prompt treatment of biliary complications are in our opinion useful in "buying time" to allow adequate development of collateral "neovascularization of the liver," thus preventing further ischemia. Conclusions: Although surgical retransplant still remains the standard treatment for hepatic artery thrombosis, organ shortages and high mortality still exist. Endovascular techniques are rapidly evolving, but these techniques are dependent on expertise available and, even in the best hands, have not proven to be effective at reversing hepatic artery thrombosis. The use of a multimodality endovascular approach could salvage the liver allografts, thereby preventing retransplant or facilitating transplant at a more elective setting.