The use of splenic artery embolization to maintain adequate hepatic arterial inflow after hepatic artery thrombosis in a split liver transplant recipient

Ricci, Kevin B.; Asharf, El-Hinnawi

doi:10.1016/j.ijscr.2018.09.003

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…Previously reported increases in hepatic arterial ow and low complication rates following splenic artery embolization in liver transplant recipients are consistent with our results [15,16,18]. To our knowledge, the literature regarding visceral artery embolization to maintain hepatic perfusion in the setting of hepatic artery pathology has been limited to case reports [22].…”

Section: Previous Studies On Direct Hepatic Artery Interventions Cons...supporting

confidence: 92%

Hepatic Artery Stenosis Following Adult Liver Transplantation: Evaluation of Different Endovascular Treatment Approaches

Desai,

Natarajan,

Khanna

et al. 2024

Preprint

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Purpose: To evaluate the efficacy and safety of hepatic artery interventions (HAI) versus extra-hepatic arterial interventions (EHAI) when managing clinically significant hepatic artery stenosis (HAS) after adult orthotopic liver transplantation. Materials and Methods: A single-center retrospective cohort analysis was conducted on liver transplant patients who underwent intervention for clinically significant HAS from September 2012 to September 2021. The HAI treatment arm included hepatic artery angioplasty and/or stent placement while the EHAI treatment arm comprised of non-hepatic visceral artery embolization. Primary outcomes included peri-procedural complications and 1-year liver-related deaths. Secondary outcomes included biliary ischemic events, longitudinal trends in liver enzymes and ultrasound parameters pre-and post-intervention. Results: The HAI arm included 21 procedures in 18 patients and the EHAI arm included 27 procedures in 22 patients. There were increased 1-year liver-related deaths (10% [2/21] vs 0% [0/27], p=0.10) and complications (29% [6/21] vs 4% [1/27], p=0.015) in the HAI group compared to the EHAI group. Both HAI and EHAI groups exhibited similar improvements in transaminitis including changes of ALT (-72 U/L vs -112.5 U/L, p=0.60) and AST (-58 U/L vs -48 U/L, p=0.56) at 1-month post-procedure. Both treatment arms demonstrated increases in post-procedural peak systolic velocity of the hepatic artery, while the HAI group also showed significant improvement in resistive indices following the intervention. Conclusion: Direct hepatic artery interventions remain the definitive treatment for clinically significant hepatic artery stenosis; however, non-hepatic visceral artery embolization can be considered a safe alternative intervention in cases of unfavorable hepatic anatomy.

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Section: Previous Studies On Direct Hepatic Artery Interventions Cons...supporting

confidence: 92%

Hepatic Artery Stenosis Following Adult Liver Transplantation: Evaluation of Different Endovascular Treatment Approaches

Desai,

Natarajan,

Khanna

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…Previously reported increases in hepatic arterial flow and low complication rates following splenic artery embolization in liver transplant recipients are consistent with our results [ 15 , 16 , 18 ]. To our knowledge, the literature regarding visceral artery embolization to maintain hepatic perfusion in the setting of hepatic artery pathology has been limited to case reports [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Hepatic artery stenosis following adult liver transplantation: evaluation of different endovascular treatment approaches

Desai,

Natarajan,

Khanna

et al. 2024

CVIR Endovasc

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Purpose To evaluate the efficacy and safety of hepatic artery interventions (HAI) versus extra-hepatic arterial interventions (EHAI) when managing clinically significant hepatic artery stenosis (HAS) after adult orthotopic liver transplantation. Materials and methods A single-center retrospective cohort analysis was conducted on liver transplant patients who underwent intervention for clinically significant HAS from September 2012 to September 2021. The HAI treatment arm included hepatic artery angioplasty and/or stent placement while the EHAI treatment arm comprised of non-hepatic visceral artery embolization. Primary outcomes included peri-procedural complications and 1-year liver-related deaths. Secondary outcomes included biliary ischemic events, longitudinal trends in liver enzymes and ultrasound parameters pre-and post-intervention. Results The HAI arm included 21 procedures in 18 patients and the EHAI arm included 27 procedures in 22 patients. There were increased 1-year liver-related deaths (10% [2/21] vs 0% [0/27], p = 0.10) and complications (29% [6/21] vs 4% [1/27], p = 0.015) in the HAI group compared to the EHAI group. Both HAI and EHAI groups exhibited similar improvements in transaminitis including changes of ALT (-72 U/L vs -112.5 U/L, p = 0.60) and AST (-58 U/L vs -48 U/L, p = 0.56) at 1-month post-procedure. Both treatment arms demonstrated increases in post-procedural peak systolic velocity of the hepatic artery distal to the stenosis, while the HAI group also showed significant improvement in resistive indices following the intervention. Conclusion Direct hepatic artery interventions remain the definitive treatment for clinically significant hepatic artery stenosis; however, non-hepatic visceral artery embolization can be considered a safe alternative intervention in cases of unfavorable hepatic anatomy. Graphical Abstract

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“…The more the blood supply from the portal vein, the less the blood supply from the hepatic artery. 12 This will affect the diagnosis of ASS to a certain extent. The portal vein blood flow reduces and the hepatic artery blood flow increases gradually over time after liver transplantation.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Color Doppler Ultrasound and Contrast-Enhanced Ultrasound in the Artery Steal Syndrome After Orthotopic Liver Transplantation

Li¹,

Gao²,

Pan³

et al. 2022

JMDH

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This study aimed to investigate the application of color Doppler ultrasound (CDU) and contrast-enhanced ultrasound (CEU) in the early diagnosis of arterial steal syndrome (ASS) after orthotopic liver transplantation (OLT). Patients and Methods: A total of 1827 patients received OLT in our department between January 2007 and December 2021, and CDU and CEU were performed after surgery. Ultrasonographic data were collected and further analyzed. ASS was confirmed by digital subtraction angiography (DSA), and the use of splenic artery embolization was dependent on the DSA findings and clinical conditions. The ultrasonographic data were collected before and after embolization. Results: ASS was found in 23 patients (23/1827; 1.26%). CDU: the portal vein velocity was higher than normal in 17 patients (52.83 ±21.74 cm/s); the hepatic artery flow signals disappeared in 7 patients; the hepatic artery velocity was 13.57±5.85 cm/s in 16 patients. In 23 patients, the spleen artery velocity was 170.12±32.04 cm/s. CEU: the hepatic artery was observed in 7 patients without hepatic artery flow signals on CDU; in 23 patients, the contrast agent reached the portal vein at the presence of contrast in the hepatic artery or earlier (difference: 2.21±1.09 s). Splenic artery embolization was done in 17 of 23 patients with ASS. The hepatic artery flow velocity, hepatic artery resistance index, splenic artery velocity and time to the presence of contrast were significantly improved after embolization (P<0.05). Conclusion: CDU and CEU are the preferred, effective tools in the diagnosis of ASS. Reduced peak hepatic artery velocity, increased spleen artery velocity and reduced time difference in the contrast reaching the portal vein and hepatic artery are indicative of ASS.

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The use of splenic artery embolization to maintain adequate hepatic arterial inflow after hepatic artery thrombosis in a split liver transplant recipient

Abstract: HighlightsCase report.Splenic artery steal syndrome can be a significant complication after liver transplant.Splenic artery steal syndrome after liver transplant can be managed by splenic artery embolization.

Cited by 4 publications

References 7 publications

Hepatic Artery Stenosis Following Adult Liver Transplantation: Evaluation of Different Endovascular Treatment Approaches

Hepatic Artery Stenosis Following Adult Liver Transplantation: Evaluation of Different Endovascular Treatment Approaches

Hepatic artery stenosis following adult liver transplantation: evaluation of different endovascular treatment approaches

Diagnostic Value of Color Doppler Ultrasound and Contrast-Enhanced Ultrasound in the Artery Steal Syndrome After Orthotopic Liver Transplantation

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