Emergency interventional endovascular treatment for early disorder of arterial blood flow in the liver graft

Abstract

Introduction. Liver transplantation is considered the most effective treatment for patients with end-stage liver disease. X-ray endovascular interventions show good results in the treatment of vascular complications after transplantation. The timing, indications and choice of treatment methods require clarification.Objective. To evaluate the safety and efficacy of emergency X-ray endovascular interventions for arterial complications in the early period after liver transplantation.Material and methods. In the period from October 2016 by July 2021, 88 liver transplants were performed. The graft was obtained from a posthumous donor in 75 cases, and from a living donor (right lobe of the liver) in 13 cases. Arterial complications were registered in 10 cases: thrombosis of the hepatic artery in 7 (8.0%), constriction in 3 (3.4%); 4 patients underwent retransplantation due to thrombosis. This analysis included 6 patients aged 27 to 51 years, including 4 men and 2 women. In the early postoperative period (0–14 days), according to laboratory parameters, ultrasound Doppler, and computed tomography with a contrast agent, an impairment of the arterial blood supply of the graft was revealed, for which the patients underwent emergency X-ray image-guided surgical endovascular interventions.Results. Restoration of adequate arterial blood supply to the liver graft was achieved in all six patients. At the time of this writing, the graft function and patency of the hepatic artery were preserved at follow-up periods of 6, 11, 12, 22 (in two patients), and 26 months with a median of 17 months. Four patients developed biliary complications that required surgical correction.Conclusion. X-ray image-guided endovascular interventions can be considered effective and relatively safe in the treatment of patients with arterial complications after liver transplantation. The period of graft arterial ischemia should be minimized as much as possible in order to prevent biliary complications.

A case of successful treatment of arterial and biliary complications in a patient after liver transplantation

“…Самый распространенный и сложный тип сосудистых осложнений -ТПА, зачастую приводящий к ишемическому повреждению желчевыводящих путей, следствием чего является образование билиарных стриктур трансплантата с риском развития септических осложнений [3,[8][9][10][11]. К факторам риска СПА/ТПА относятся нетипичная артериальная анатомия печени, особенно в случаях несоответствия «калибров» при формировании артериального анастомоза печеночного графта, дефекты хирургической техники при изъятии трансплантата, длительное время холодовой и тепловой ишемии.…”

“…(2021) представили опыт 88 трансплантаций печени (75 ОТП, 13 -родственных): в послеоперационном периоде у 10 пациентов получены артериальные осложнения (7 -ТПА, 3 -СПА); 6 больным провели экстренное рентгенэндоваскулярное вмешательство, в результате которого достигли восстановления адекватного артериального кровоснабжения графта. Авторы статьи пришли к выводу, что малоинвазивная, интервенционная коррекция сосудистых осложнений эффективна и безопасна в отношении больного, а период артериальной ишемии трансплантата должен быть предельно минимизирован с целью предупреждения билиарных осложнений [8].…”