Endovascular treatment of stenosis between hepatic vein and inferior vena cava following liver transplantation in a child: A case report

Abstract

The liver transplantation technique advances have allowed the endovascular treatment of stenosis between hepatic vein and inferior vena cava, and this has become an established and widely acceptable method for the treatment of patients with end-stage liver disease. However, in spite of the advances in the surgical technique of liver transplantation there is relatively still a high incidence of postoperative complications, especially those related to vascular complications. One technical variant of orthotopic liver transplantation is the piggyback technique with conservation of the recipient vena cava, which is anastomosed to the graft hepatic veins. As a consequence of the increased number of liver transplants in children, there is a higher demand for endovascular treatment of vascular stenosis, such as those at the level of the hepatic veins. This leads to more consistent experience of endovascular treatment of the surgical vascular complications following liver transplantation. This article describes the case of a child submitted to liver transplantation with reduced graft (left lateral segment) who presented stenosis of the anastomosis between the hepatic vein and IVC 6 months later which was successfully treated by PTA.

Pediatric Liver Transplantation: A Pictorial Essay of Early and Late Complications

“…Risk factors include technical problems during transplantation, use of intravascular catheters, and compression of vessels by a fluid collection. IVC obstruction can cause lower extremity edema (41,44).…”

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“…8,21 In addition to hemorrhage, procedure-related complications include rethrombosis, vascular dissection, or even rupture. 22 Ultrasound-accelerated thrombolysis is emerging as a promising tool in many vascular beds, including in peripheral arterial, 23 venous, 24 portal, 25 pulmonary, 25,26 and even in intracerebral vasculature. 27 High-frequency ultrasound waves synergistically enhance the fibrinolytic effects of the thrombolytic due to direct-mechanical acoustic streaming, improving clot permeability via creation of micropores and thus potentially reducing tPA doses and infusion rates.…”

Minimal Invasive (Endovascular and Percutaneous) Treatment of Post Liver Transplantation Complications in Pediatrics

“…Inferior Vena Cava (IVC) stenosis is more common in the pediatric population, especially among recipients of partial liver transplants, including living donor liver transplants, reduced-size liver transplants, and split liver transplants (Carnevale et al, 2004;Egawa et al, 1997). IVC stenosis may occurs acutely secondary to an anastomotic size discrepancy or suprahepatic caval kinking from organ rotation.…”

“…IVC stenosis may occurs acutely secondary to an anastomotic size discrepancy or suprahepatic caval kinking from organ rotation. Delayed caval stenosis may occur secondary to fibrosis, a chronic thrombus, or neointimal hyperplasia (Carnevale et al, 2004;Katyal et al, 2000). Clinical manifestations include pleural effusions, hepatomegaly, ascites, and lower extremity edema.…”

“…Frequently, cavogram is required to confirm the stenosis. Pressure gradient measurements can help distinguish physiologically significant lesions from pseudostenoses (Carnevale et al, 2004). Treatment includes IVC recanalization, balloon angioplasty and stent placement (Fig.…”