Endovascular Therapy for Hepatic Artery Stenosis and Thrombosis Following Liver Transplantation

Abstract

Endovascular management is effective for HAS but not for HAT.

Primary stent placement for hepatic artery stenosis after liver transplantation

“…[1][2][3] HAT carries a 30% to 50% incidence of eventual liver failure and represents >50% of all arterial complications in OLT. [4][5][6][7][8][9] Developing HAT significantly increases a recipient's morbidity and mortality and may require retransplantation in up to 75% of cases.…”

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

“…Significant HAS is usually defined as a narrowing of the transverse diameter > 50% on angiogram associated with clinical suspicion and a RI < 0.5 (defined by peak systolic flowend diastolic flow/peak systolic flow) and a peak systolic velocity > 400 cm/s detected by DUS [16,57,58] . HAS and HAT are the most common hepatic arterial complications, with high rates of morbidity and mortality [56,58] (Table 3).…”

Use of Coronary Techniques in Celiac and Hepatic Artery Stenting in Post-Hepatic Transplant Patients

“…Suspected HAS can be confirmed on CT angiography or traditional catheterbased angiography. PTA has been shown to have a technical success rate of 81-93% in larger HAS trials 5 and up to 97-100% in smaller trials. 6 PTA has been shown to decrease the incidence of hepatic artery thrombosis from 65% to 19% 3 in patients presenting with HAS after transplantation.…”

“…3 Utilization of coronary-based techniques for treatment of hepatic artery stenosis has been widely reported in the literature. 5,6 Vessel diameters are often in the range of 2.5-5.0 mm, making coronary equipment a natural choice. Multipurpose coronary guides work well to engage the celiac artery, and 0.014-inch wires with excellent maneuverability work well when encountering severe stenoses or significant tortuosity.…”

“…Less frequently, it is associated with allograft rejection, microvascular injury associated with cold preservation injury, or extrinsic compression. 2,5 Patients who develop HAS postoperatively have approximately a 65% chance of developing hepatic artery thrombosis, which can be a devastating complication leading to severe biliary damage, acute liver dysfunction and, ultimately, allograft failure. 3 In addition to HAS, other vascular complications that should be assessed include hepatic artery kinking related to excessive vessel length, pseudoaneurysm and arterial dissection.…”