Is Routine Intraoperative Contrast‐Enhanced Ultrasonography Useful During Whole Liver Transplantation?

Golse, Nicolas; Santoni, Simone; Karam, Vincent; Ciacio, Oriana; Pittau, Gabriella; Allard, Marc‐Antoine; Cherqui, Daniel; Cunha, Antonio Sa; Adam, René; Castaing, Denis; Vibert, Éric

doi:10.1007/s00268-017-4295-x

Cited by 5 publications

(7 citation statements)

References 49 publications

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“…Of the 7 grafts that were lost, 1 patient developed graft-related gall bladder cancer but died of an unrelated metastatic epidermoid tongue cancer. 28 The remaining 6 patients had HA thrombosis. 1 , 4 , 9 , 23 , 29 One of these had an early HAT after an aortohepatic jump graft and underwent a reoperation with prosthetic graft interposition.…”

Section: Resultsmentioning

confidence: 99%

“…15 Three nongraft-related complications resulted in the death of these patients post-liver transplant. 9 , 28 …”

Section: Resultsmentioning

confidence: 99%

“…Based on available data, the decision to undertake a MAL intervention was taken before an OLT in 43%, intraoperatively in 43% and postoperatively in 14% of patients. 1-4,6-8,11-13,16,17,21-25,27-29…”

Section: Resultsmentioning

confidence: 99%

“…Computerized tomography (CT) [1][2][3]6,8,9,11,17,21,23,25,28,29 and duplex ultrasound 1,3,6,7,[11][12][13]17,22,23,25,26,28 were the radiological modalities most frequently used to diagnose and facilitate the management of MAL.…”

Section: Radiological Investigations Before Mal Interventionmentioning

confidence: 99%

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Contemporary Management of Median Arcuate Ligament in Liver Transplantation

Babu¹,

Oniscu²

2022

Transplantation Direct

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Liver TransplantationBackground. Median arcuate ligament (MAL) can impair arterial inflow during orthotopic liver transplantation (OLT). Furthermore, approaches to ensure optimal vascular inflow in the presence of MAL is not standardized. Methods. We undertook a systematic review according to the Cochrane systematic review protocol and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We analyzed the incidence of MAL, investigations, treatment options, and potential complications associated with MAL intervention in patients undergoing OLT. After the exclusion criteria were implemented, the dataset from the final 21 manuscripts yielded 117 patients who underwent a liver transplant in the presence of MAL. Results. The incidence of MAL in patients undergoing OLT is between 1.6% and 12%. In 63.2% of cases, an open approach for MAL intervention was undertaken. Hepatic artery thrombosis developed in 17% (7) patients without MAL intervention versus 2.6% (2) after MAL intervention. Seven grafts (5.9%) were lost after OLT in patients with MAL. Three (3.9%) patients developed arterial stenosis post-MAL intervention. Conclusions. We propose an algorithm for intraoperative assessment and management of liver transplant arterial inflow in the presence of MAL based on the hepatic artery flow changes with respiration, following clamping of the recipient gastroduodenal artery. In the presence of a 30%-50% flow variation on respiration, the arterial inflow should be established preserving additional inflow from the recipient gastroduodenal artery. Consider an open MAL release if the flow remains insufficient. A poor arterial flow with no variation with respiration and lack of evidence of aortoiliac atherosclerosis indicates the need for arterial jump graft.

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Section: Resultsmentioning

confidence: 99%

“…15 Three nongraft-related complications resulted in the death of these patients post-liver transplant. 9 , 28 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Radiological Investigations Before Mal Interventionmentioning

confidence: 99%

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Contemporary Management of Median Arcuate Ligament in Liver Transplantation

Babu¹,

Oniscu²

2022

Transplantation Direct

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“…However, the perioperative hepatic artery flow is determined by various factors, making it difficult to determine whether the blood flow is adequate[ 8 ]. Golse et al [ 30 ] used intraoperative contrast-enhanced Doppler ultrasonography to determine the hepatic blood flow in OLT patients. In their reports, MALS patients who required further treatment and six patients with weak arterial flow without intervention underwent MAL division and the incidence of postoperative vascular complications was significantly reduced.…”

Section: Discussionmentioning

confidence: 99%

Feasible management of median arcuate ligament syndrome in orthotopic liver transplantation recipients

Li¹,

Fan²,

Tian³

et al. 2022

World J Gastrointest Surg

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BACKGROUND In orthotopic liver transplantation (OLT) recipients, median arcuate ligament syndrome (MALS) is considered a risk factor for hepatic arterial thrombosis (HAT), which is dreadful for OLT recipients. Different alternative surgical procedures have been proposed to overcome the impact of MALS on transplantation, but clinical evidence is still scarce. AIM To evaluate the feasible surgical management of MALS to reduce complications in OLT patients. METHODS Data for 288 consecutive patients who underwent OLT at The First Hospital of Jilin University between January 2017 and July 2020 were retrospectively reviewed. The surgical management of median arcuate ligament (MAL) and modifications to the arterial anastomosis were recorded. The perioperative and long-term prognosis of MALS recipients were noted. Detailed preoperative and postoperative data of patients were analyzed in a descriptive manner. RESULTS Eight patients with MALS were included in this study. The first patient with MALS received no intervention during the primary surgery and developed postoperative HAT. Salvage liver transplantation with MAL division was successfully performed. Gastroduodenal artery (GDA) preservation with splenic artery ligation was performed on three patients, only GDA preservation was performed on two patients, and no intervention was performed on two patients. No patient developed HAT after surgery and postoperative recovery was satisfactory. CONCLUSION The preservation of collateral circulation between the superior mesenteric artery and celiac trunk via the GDA with or without splenic artery ligation is a safe and feasible alternative to MAL division.

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Advanced ultrasound applications in the assessment of renal transplants: contrast-enhanced ultrasound, elastography, and B-flow

et al. 2018

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Ultrasound is routinely used as the first imaging exam for evaluation of renal transplants and can identify most major surgical complications and evaluate vascularity with color Doppler. Ultrasound is limited, however, in the detection of parenchymal disease processes and Doppler evaluation is also prone to technical errors. Multiple new ultrasound applications have been developed and are under ongoing investigation which could add additional diagnostic capability to the routine ultrasound exam with minimal additional time, cost, and patient risk. Contrast-enhanced ultrasound (CEUS) can be used off-label in the transplant kidney, and can assist in detection of infection, trauma, and vascular complications. CEUS also can demonstrate perfusion of the transplant assessed quantitatively with generation of time-intensity curves. Future directions of CEUS include monitoring treatment response and microbubble targeted medication delivery. Elastography is an ultrasound application that can detect changes in tissue elasticity, which is useful to diagnose diffuse parenchymal disease, such as fibrosis, otherwise unrecognizable with ultrasound. Elastography has been successfully applied in other organs including the liver, thyroid, and breast; however, it is still under development for use in the transplant kidney. Unique properties of the transplant kidney including its heterogeneity, anatomic location, and other technical factors present challenges in the development of reference standard measurements. Lastly, B-flow imaging is a flow application derived from B-mode. This application can show the true lumen size of a vessel which is useful to depict vascular anatomy and bypasses some of the pitfalls of color Doppler such as demonstration of slow flow.

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Is Routine Intraoperative Contrast‐Enhanced Ultrasonography Useful During Whole Liver Transplantation?

Abstract: This study demonstrated the feasibility of CE-IOUS during whole LT. However, we failed to demonstrate any advantages of CE-IOUS over IOUS. Therefore, IOUS currently remains the gold-standard imaging technique for the intraoperative assessment of vascular patency.

Cited by 5 publications

References 49 publications

Contemporary Management of Median Arcuate Ligament in Liver Transplantation

Contemporary Management of Median Arcuate Ligament in Liver Transplantation

Feasible management of median arcuate ligament syndrome in orthotopic liver transplantation recipients

Advanced ultrasound applications in the assessment of renal transplants: contrast-enhanced ultrasound, elastography, and B-flow

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