Catheter Thrombolysis of Thrombosed Hepatic Arteries in Liver Transplant Recipients: Predictors of Success and Role of Thrombolysis

Abstract

Hepatic artery thrombosis is an uncommon complication of liver transplantation. However, it is a major indication for re-transplantation. The use of transcatheter thrombolysis and subsequent surgical revascularization as a graft salvage procedure is discussed. Four of 5 cases (80%) were successful in re-establishing flow and uncovering underlying arterial anatomic defects. None were treated definitively by endoluminal measures due to an inability to resolve the underlying anatomic defects. However, 2 of 5 cases (40%) went on to a successful surgical revascularization and represent successful long-term outcome of transcatheter thrombolysis followed by definitive surgical revascularization. We conclude that, definitive endoluminal success cannot be achieved without resolving associated, and possibly instigating, underlying arterial anatomical defects. However, reestablishing flow to the graft can unmask underlying lesions as well as asses surrounding vasculature thus providing anatomical information for a more elective, better planned and definitive surgical revision.

Vascular complications following liver transplantation: A literature review of advances in 2015

“…In recent years, early revascu larization by means of endovascular catheterbased intervention has been a viable option for graft salvage before considering retransplantation. Indeed, the retrans plantation rate is very high in untreated HAT (25%83%) compared to graft revascularization treated patients (28%35%) [3,10,13,16,17,30,3240] . Table 2 Hepatic artery thrombosis highlights…”

“…Early diagnosis, prompt revascularization and retransplantation have been considered the only solution to rescue patients with HAT. Historically, retransplantation is the treatment of choice for most groups, offering the best survival results [5,16] . However, this possibility is strongly conditioned by the shortage of donors and by the patient's condition [16,17,27,38,39] .…”

“…Historically, retransplantation is the treatment of choice for most groups, offering the best survival results [5,16] . However, this possibility is strongly conditioned by the shortage of donors and by the patient's condition [16,17,27,38,39] . Percutaneous endovascular treatments including intra arterial thrombolysis (IAT), percutaneous transluminal angioplasty (PTA) and stent placement have shown hopeful outcomes in the literature.…”

“…It is the most frequent and severe vascular complication following OLT. Table 2 usually more fre quent after pediatric liver transplantation [5,10,16,17,2831] . It is the first cause of primary non-function of the liver transplant, which can lead to allotransplant loss and patient death in the early postoperative period.…”

Interventional radiology procedures in adult patients who underwent liver transplantation

“…Surgical thrombectomy and/or re-transplantation should be reserved for cases in which percutaneous techniques fail. Saad et al [11] reported successful in re-establishment of arterial …”