Hepatic Artery Thrombosis After Orthotopic Liver Transplantation: 3 Patients With Collateral Formation and Conservative Treatment

Fouzas, I.; Sklavos, A.; Bismpa, K.; Paxiadakis, I.; Antoniadis, Nikolaos; Giakoustidis, Dimitrios; Katsiki, Evangelia; Tatsou, N.; Mouloudi, Eleni; Karapanagiotou, A.; Tsitlakidis, Abraham; Karakatsanis, Anestis; Patsiaoura, Kalliopi; Petridis, Anastasios; Gakis, D.; Ιmvrios, G.; Papanikolaou, Vasilis K.

doi:10.1016/j.transproceed.2012.09.002

Cited by 30 publications

(13 citation statements)

References 9 publications

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“…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.…”

Section: Diagnosismentioning

confidence: 99%

“…Percutaneous endovascular treatments including intra arterial thrombolysis (IAT), percutaneous transluminal angioplasty (PTA) and stent placement have shown hopeful outcomes in the literature. Finally, some patients survive without revascularization or retransplantation by developing collateral circulation distal to the thrombosis, but this occurs in rare cases [17,20,24,38,39] . Despite these encouraging results of endovascular interventions, the efficacy and risk of complications (mainly represented by hemorrhage risk) make this therapeutic option still controversial.…”

Section: Diagnosismentioning

confidence: 99%

“…The mean time between the diagnosis of HAT and the neovascularized liver is 4.1 mo (range: 3-5.5 mo). Four factors are associated with the development of a neovascularized liver: Late HAT, early HAS, site of thrombosis, and RouxenY anastomosis [24,39] . These results confirm that a slow arterial obstruction process allows for the formation of arterial substitute pathways, but this striking neoangiogenesis capacity, only signi ficant in cases of chronic ischemia, is insufficiently rapid in the case of early HAT.…”

Section: Diagnosismentioning

confidence: 99%

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

Piardi¹

2016

WJH

167

159

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Although vascular complications (VCs) following orthotopic liver transplantation (OLT) seldom occur, they are the most feared complications with a high incidence of both graft loss and mortality, as they compromise the blood flow of the transplant (either inflow or outflow). Diagnosis and therapeutic management of VCs constitute a major challenge in terms of increasing the success rate of liver transplantation. While surgical treatment used to be considered the first choice for management, advances in endovascular intervention have increased to make this a viable therapeutic option. Considering VC as a rare but a major and dreadful issue in OLT history, and in view of the continuing and rapid progress in recent years, an update on these uncommon conditions seemed necessary. In this sense, this review comprehensively discusses the important features (epidemiological, clinical, paraclinical, prognostic and therapeutic) of VCs following OLT. Core tip: Although vascular complications (VCs) following orthotopic liver transplantation (OLT) seldom occur, they are the most feared complications with a high incidence of both graft loss and mortality, as

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

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

Piardi¹

2016

WJH

167

159

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“…The clinical presentation of hepatic artery thrombosis in our patient has been described in the medical literature 10 . It is occasionally an incidental finding during follow-up.…”

Section: Management Of Our Patientmentioning

confidence: 66%

Recurrent hepatic artery thrombosis in three instances of liver transplant in a single patient: Case report

Acosta-Martínez

Guerrero-Domínguez

Rodríguez

et al. 2015

Colombian Journal of Anesthesiology

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“…Fouzas and colleagues described their experience with 3 patients in which development of collateral arterial flow was beneficial and saved patients from transplant. 40 The phenomenon of a "neovascularized liver" is poorly understood. It has been attributed to angiogenesis, which may involve the omentum and is believed to display angiogenic potential to promote neovascularization in chronically ischemic organs.…”

Section: Treatment Of Hepatic Artery Thrombosismentioning

confidence: 99%

Untitled

Pereira

Salsamendi²,

Dalal

et al. 2016

Exp Clin Transplant

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Objectives: Hepatic artery thrombosis remains a major complication after orthoptic liver transplant. Treatment of hepatic artery thrombosis is complex and requires a multidisciplinary approach. Retransplant is the procedure of choice. In nonsurgical candidates, endovascular options are evolving. Materials and Methods: Based on our experience at a busy transplant center, we discuss 4 representative cases to explain the potential role of endovascular treatment beyond just attempts at recanalization. From our experience, as well as a review of the literature, we propose a clinical practice algorithm for optimal treatment of hepatic artery thrombosis after orthoptic liver transplant. Results: The primary traditional endovascular interventional options remain thrombectomy, balloon angioplasty, and use of stents with the aim of revascularization. However, these methods have not proven to be effective. Ultrasonography-assisted thrombolysis, which has thus far been relatively less described in the hepatic vasculature, has the potential of producing the same angiographic results but at lower doses of the thrombolytic agent, thus decreasing the potential for hemorrhagic complications. The adjunctive use of splenic artery embolization and prompt treatment of biliary complications are in our opinion useful in "buying time" to allow adequate development of collateral "neovascularization of the liver," thus preventing further ischemia. Conclusions: Although surgical retransplant still remains the standard treatment for hepatic artery thrombosis, organ shortages and high mortality still exist. Endovascular techniques are rapidly evolving, but these techniques are dependent on expertise available and, even in the best hands, have not proven to be effective at reversing hepatic artery thrombosis. The use of a multimodality endovascular approach could salvage the liver allografts, thereby preventing retransplant or facilitating transplant at a more elective setting.

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Hepatic Artery Thrombosis After Orthotopic Liver Transplantation: 3 Patients With Collateral Formation and Conservative Treatment

Cited by 30 publications

References 9 publications

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

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

Recurrent hepatic artery thrombosis in three instances of liver transplant in a single patient: Case report

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