Hepatic artery anastomotic stenosis after transplantation: treatment with percutaneous transluminal angioplasty.

Abstract

Two orthotopic liver transplant recipients underwent percutaneous transluminal angioplasty (PTA) for stricture of the hepatic arterial anastomosis. In both, arterial revascularization was effected by end-to-end anastomosis between the donor common hepatic artery and the recipient's hepatic artery. Both patients had elevated liver enzyme levels, abnormal results on duplex Doppler images, and severe stricture on angiograms. In one patient, percutaneous biopsy revealed graft ischemia. PTA was performed successfully without complications. PTA produced substantial improvement in biochemical, duplex Doppler, histologic, and angiographic patterns. Both patients were asymptomatic 5 and 6 months after PTA.

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

“…Delayed complications (i.e., HAT) within 30 d of PTA occurred in 5% of cases, yielding a total complication rate of 12% and 12% total failed attempts without consequences. In this treatment modality, very different rates of restenosis have been reported from no restenosis to rates as high as 75% [60,63,64,67,68] . Denys et al [60] (2002) reported a low rate of HAT among 13 HAS patients treated by HA stent placement, which may be attributed to anticoagulation and/or antiplatelet regimens that were routinely given to their patients [52,60] .…”

Dissection of an iliac artery conduit to liver allograft: Treatment with an endovascular stent

“…3,4 In transplant recipients presenting with arterial anastomotic strictures, transluminal balloon angioplasty has been successfully performed. 3,[6][7][8] In the transplant setting, the immediate technical success rates for angioplasty of anastomotic strictures is between 70% and 85%, with excellent long-term outcomes. 6,8 Stenting across an anastomotic stricture has been reported, 5 although …”

“…When surgery is not advisable or feasible, endovascular techniques can reestablish arterial inflow and/or permit new collaterals to develop, thus salvaging the allograft. These techniques after OLT have not been widely used, [5][6][7] partly because of the challenging anatomy. We describe a liver transplant recipient who developed a dissection of an iliac artery conduit to the allograft, likely resulting from the atherosclerotic nature of the donor vessels, that was successfully treated with an endovascular stent.…”

Angioplastia subintimal após trombose tardia de stent implantado em artéria hepática de fígado transplantado

“…The hepatic artery of a transplanted liver plays an essential role in graft perfusion, as it is the main blood supply to the biliary ducts [1][2][3] . In case of reduced or absent arterial flow, biliary duct ischemia may occur and, consequently, cholestasis and its complications.…”

“…Hepatic artery stenosis is a complication of liver transplantation, with an incidence that ranges from 4.8 to 12% [1][2][3] . Out of these cases, about 65% develop secondary thrombosis 1,2 .…”