Management of Venous Outflow Complications After Liver Transplantation

Darcy, Michael

doi:10.1053/j.tvir.2007.09.018

Cited by 93 publications

(80 citation statements)

References 23 publications

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“…The main risk factor leading to caval anastomosis complications (CACs) is represented by technical errors in the connection of caval anastomoses, which lead to kinking or thrombosis in the early postoperative course. In the late postoperative period, chronic stenosis in the anastomotic area is the result of fibrosis, hyperplasia and/or extrinsic compression from the enlarged liver graft [2,136,137] . Diagnosis should be achieved by DUS, contrastenhanced CT, and finally by cavography which allows for providing treatment.…”

Section: Caval Vein Complicationsmentioning

confidence: 99%

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: Caval Vein Complicationsmentioning

confidence: 99%

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

Piardi¹

2016

WJH

167

159

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“…A transhepatic approach and the use of a metallic stent are reserved for unresponsive patients. 6,[9][10][11] Figure 2 shows a 2-year-old female patient who presented with ascites due to hepatic outflow stenosis after liver transplant. The patient received angioplasty, with successful reduction of pressure gradient from 15 mm Hg to 4 mm Hg and clinical improvement.…”

Section: Hepatic Vein Stenosismentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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Objectives: Recipients of liver transplant are surviving longer as both the surgical procedure and postsurgical care have improved. Despite improvements, serious complications from the procedure remain that significantly affect patient outcome and may result in retransplant. Refractory ascites is one complication, occurring in about 5.6% of transplant recipients. Management of refractory ascites after liver transplant presents a challenge to the multidisciplinary team caring for these patients. Materials and Methods:We discuss approaches to the diagnosis and treatment of refractory ascites after liver transplant, based on a literature review, with a primary focus on vascular causes. These approaches are illustrated by case examples highlighting our experiences at an academic tertiary medical center. We propose a clinical practice algorithm for optimal endovascular treatment of refractory ascites after liver transplant. Results: The cornerstone of refractory ascites care is diagnosis and treatment of the cause. Vascular causes are not infrequently encountered and, if not treated early, are associated with graft loss and high morbidity and mortality and are major indications for retransplant. For patients with recurrent disease or graft rejection needing large volume paracentesis, the use of a transjugular intrahepatic portosystemic shunt may serve as a bridge to more definitive treatment (retransplant), although it may not be as effective for managing ascites as splenic artery embolization, arguably underused, which is emerging as a potential alternative treatment option. Conclusions: A multidisciplinary strategy for the diagnosis and care of patients with refractory ascites after liver transplant is crucial, with endovascular treatment playing an important role. The aim is for this document to serve as a concise and informative reference to be used by those who may care for patients with this rare yet serious diagnosis.

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“…[6][7][8] In the present report, we describe an IVC stenosis of a different etiology: chronic thrombotic suprahepatic IVC stenosis in a liver transplant recipient associated with polycystic hepatomegaly and diagnosed intraoperatively by TEE.…”

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confidence: 99%

“…The diagnosis of IVC stenosis is traditionally based on imaging and clinical presentation and may take hours to days. 7,8 In that sense, TEE is a uniquely valuable diagnostic tool because no other routine intraoperative monitor could have detected this lesion in such a timely fashion. The rapid diagnosis had an immediate impact on patient management and prompted the institution of anticoagulation, close follow-up, and consideration of interventions.…”

mentioning

confidence: 99%

“…6,8 Because the risks of dislodging the mural thrombus or migrating the stent into the RA and covering the HVs were estimated to be high, we decided against intervening. Angioplasty and open surgical repair were not considered because of the nonlasting benefits of the former approach and the high risk of complications and likely need for cardiopulmonary bypass with the latter approach.…”

mentioning

confidence: 99%

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