Case report of hepatic artery dissection secondary to hepatic artery pseudoaneurysm after living donor liver transplantation

Ma, Lin; Chen, Kefei; Lu, Qiang; Ling, Wenwu; Luo, Yan

doi:10.1186/s12876-016-0458-8

Cited by 12 publications

(7 citation statements)

References 24 publications

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“…After LT, the only arterial flow to the graft liver is through hepatic artery (HA) anastomosis. Hepatic artery thrombosis (HAT) is one of the most severe complications after LDLT, and it may lead to graft loss and death of the transplant recipient . HAT is the most common vascular complication of LDLT, with estimated incidence rates ranging from 2.5% to 11% .…”

Section: Introductionmentioning

confidence: 99%

“…Hepatic artery thrombosis (HAT) is one of the most severe complications after LDLT, and it may lead to graft loss and death of the transplant recipient. (3,4) HAT is the most common vascular complication of LDLT, with estimated incidence rates ranging from 2.5% to 11%. (5,6) Furthermore, HAT remains one of the major causes of graft failure and transplant recipient mortality.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Course of Hepatic Artery Thrombosis After Living Donor Liver Transplantation Using the Right Lobe

Choi

Kim

et al. 2018

Liver Transpl

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Hepatic artery thrombosis (HAT) can result in biliary tree necrosis and graft loss, necessitating retransplantation. The most effective treatment approach is still controversial. This study was performed to review the outcomes of HAT after living donor liver transplantation (LDLT) and to clarify the feasibility of different strategies. From May 1996 to August 2017, LDLT using the right lobe was performed in 827 adult patients in our center. Our technique of hepatic artery (HA) reconstruction is end-to-end anastomosis under a microscope (10×). Diagnosis of HAT was performed using Doppler sonography and computed tomography (CT) angiography. HAT was initially treated with surgical or endovascular procedure, and retransplantation was considered according to the graft condition. Among the 827 cases of LDLT using the right lobe, HAT occurred in 16 (1.9%) cases within 1 month after transplantation. Within the first week, 7 of these HAT cases (43.8%) occurred (early HAT), while the remaining 9 cases (56.2%) occurred between the first week and 1 month (late HAT). The incidence of graft failure was high in early HAT (42.9%), and the frequency of biliary complications was high in late HAT (77.8%). The success rate of HA recanalization was 62.5% (10/16): 100% (5/5) after reoperation and 45.5% (5/11) after the endovascular procedure. Of the patients in whom treatment failed in late HAT (n = 5), 4 underwent neovascularization during observation. A total of 5 patients underwent graft failure, and 3 of these patients underwent repeat liver transplantation (LT). Mortality occurred in 3 patients, including 1 in the surgical group and 2 in the endovascular group. In conclusion, early diagnosis and aggressive treatment of HAT are necessary to avoid graft failure, and the choice of treatment depends on various factors. Although further studies are required, early HAT requires preparation for graft failure, while late HAT requires treatment for biliary complications.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Course of Hepatic Artery Thrombosis After Living Donor Liver Transplantation Using the Right Lobe

Choi

Kim

et al. 2018

Liver Transpl

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“…The value of bedside ultrasound as a noninvasive, cost-effective, radiationfree diagnostic option has also been shown for other clinical intensive care scenarios, e. g., after liver transplantation [8]. Highly important for these patients is the rapid diagnosis of stenoses, false aneurysms, thromboses, and dissections in the hepatic artery.…”

Section: Discussionmentioning

confidence: 99%

“…Highly important for these patients is the rapid diagnosis of stenoses, false aneurysms, thromboses, and dissections in the hepatic artery. Particularly contrast-enhanced ultrasound significantly improves visualization, while simultaneously enabling evaluation of perfusion in the liver parenchyma [3,8]. A comparison between the diagnostic accuracy of contrast-enhanced ultrasound and that of a native CT examination in patients with kidney failure revealed correct characterization of liver, kidney, and intestinal pathologies in 96%, 89%, and 100% of cases for contrast-enhanced ultrasound versus 0%, 7%, and 18% for native CT, respectively [13].…”

Section: Discussionmentioning

confidence: 99%

Bedside ultrasound after aortic surgery

et al. 2019

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Bedside ultrasound after aortic surgery Rapid detection of vascular and organ complications Vessel and organ complications occur after both open and endovascular aortic surgery. These include vascular access complications, such as bleeding and acute ischemia in cases of occlusion or dissection and also hepatic, renal and intestinal ischemia. Rapid and targeted diagnostics are essential for avoidance of long-term damage and to reduce morbidity and mortality. Bedside color duplex and contrast-enhanced ultrasound can be used in the intensive care unit for rapid diagnosis of early complications after these interventions.

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“…Beyond HA anatomic variations, occurring in ~24% of the United States population as described by Hiatt et al, 1 poor HA compatibility may also derive from narrow diameter, stenosis, and injury. Moreover, transarterial chemoembolization (TACE) and the rare postoperative vascular complications of HA pseudoaneurysm 2 and HA thrombosis (HAT) 3 may necessitate measures exceeding standard HA reconstruction to preserve hepatic blood flow. Multiple techniques have been described to achieve extra-anatomic HA reconstruction, many of which utilize donor-derived arterial grafts and originate from the recipient’s infra- or suprarenal aorta or right iliac artery.…”

mentioning

confidence: 99%

Splenic Artery Transposition for Liver Transplantation: An Underutilized Technique?

Goss

Galván

Geha

et al. 2021

Transplantation Direct

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Background. Successful liver transplantation is dependent on restoration of hepatic arterial (HA) flow. Although uncommon, some native recipient HAs are not suitable or inadequate for anastomosis, thereby necessitating extra-anatomic HA reconstruction. Splenic artery transposition (SAT) is 1 method of HA reconstruction, in which the recipient splenic artery is transposed to reestablish perfusion of the donor liver. Due to the rarity of the technique, literature describing outcomes is limited. In the current report, we describe 3 patients (2 adults, 1 pediatric) who underwent complex upper abdominal surgery before whole-organ deceased donor liver transplantation with SAT. Methods. The demographic and patient care information was collected prospectively and subsequently reviewed retrospectively. Given the de-identified nature of the data included, this study was exempt from approval from an ethics board. Results. Recipient splenic arteries were dissected from their origin at the celiac trunk, for approximately 3–5 cm to ensure a gentle anterior-cranial curve toward the right upper quadrant, allowing anastomosis to the donor celiac trunk in an end-to-end fashion. Postoperatively, all 3 patients had rapid normalization of liver function tests and brisk HA flow demonstrated by Doppler ultrasound. Longer-term follow-up, ranging from 1 to 3 years, reveals continued patency of the reconstructed HAs and liver function tests within normal limits. Conclusions. Our experience points to SAT as a safe and effective technique for extra-anatomic HA reconstruction.

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Case report of hepatic artery dissection secondary to hepatic artery pseudoaneurysm after living donor liver transplantation

Cited by 12 publications

References 24 publications

Clinical Course of Hepatic Artery Thrombosis After Living Donor Liver Transplantation Using the Right Lobe

Clinical Course of Hepatic Artery Thrombosis After Living Donor Liver Transplantation Using the Right Lobe

Bedside ultrasound after aortic surgery

Splenic Artery Transposition for Liver Transplantation: An Underutilized Technique?

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