Inferior Vena Cava Torsion and Stenosis Complicated by Compressive Pericaval Regional Ascites following Orthotopic Liver Transplantation

Alli, Adam; Gilroy, Richard; Johnson, Philip L.

doi:10.1155/2013/576092

Cited by 3 publications

(5 citation statements)

References 11 publications

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“…A significant gradient across the stenosis is defined as 7-10 mm Hg (84). There are a few reports of IVC torsion following OLT, including a report of intermittent IVC torsion and stenosis complicated by compressive regional ascites (85). Most of the cases are due to stenosis at either the IVC or one of the hepatic veins; however, concurrent suprahepatic IVC and hepatic vein stenosis after the surgery has also been reported (82).…”

Section: Ivc Occlusion/torsion and Stenosismentioning

confidence: 99%

A Comprehensive Approach to Hepatic Vascular Disease

et al. 2017

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The liver has a complex vascular supply, which involves the inflow of oxygenated blood through the hepatic artery (systemic circulation) and deoxygenated blood through the portal vein (portal circulation), as well as the outflow of deoxygenated blood through the hepatic veins to the inferior vena cava. A spectrum of vascular variants can involve the liver. Some of these variants may result in areas of enhancement that can mimic more serious pathologic conditions. In this article, the authors discuss a spectrum of variants and pathologic conditions that may involve the liver vasculature. These include variants, anomalies, and diseases involving the portal vein, such as rudimentary portal vein, thrombosis, cavernous transformation, thrombotic angiitis, thrombophlebitis, transient hepatic attenuation difference or transient hepatic intensity difference, portal venous aneurysm, and portal vein gas. The hepatic artery can be involved by various diseases, including thrombosis, stenosis, and aneurysm or pseudoaneurysm. Unusual "third inflow" sources of venous inflow are also discussed, including aberrant right gastric vein, aberrant left gastric vein, epigastric-paraumbilical veins, and cholecystic vein. A spectrum of variants and diseases involving the inferior vena cava and hepatic veins, including thrombosis, Budd-Chiari syndrome, veno-occlusive disease, stenosis, torsion, congestive hepatopathy, and peliosis hepatis, are discussed. Vascular shunts are illustrated, including portosystemic shunts (intra- and extrahepatic), arterioportal shunt, shunts of hereditary hemorrhagic telangiectasia, and acquired arteriovenous fistula. Familiarity with the pathogenesis and imaging features of these vascular entities can aid radiologic diagnoses and guide appropriate patient management. RSNA, 2017.

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Section: Ivc Occlusion/torsion and Stenosismentioning

confidence: 99%

A Comprehensive Approach to Hepatic Vascular Disease

et al. 2017

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“…Stenosis associated with twisting of the IVC is a rare technical complication which can occur at the site of the anastomosis especially in the suprahepatic anastomosis as described in this patient [1, 2]. There are a few case reports about twisting or stenosis being the cause of IVC thrombosis with the commonest site being the retrohepatic IVC [3]. In this patient, the stenosis and twist and the resultant thrombus occurred at the junction of the IVC with the right atrium.…”

Section: Discussionmentioning

confidence: 85%

Intravascular Thrombolysis Followed by Stenting as Management of Retrohepatic Inferior Vena Caval Thrombosis due to a Twist in the Inferior Vena Cava after Deceased Donor Liver Transplant

Kituuka

Rai

Thorat

et al. 2019

Case Reports in Surgery

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Inferior vena cava (IVC) occlusion due to acute thrombosis is a rare but important vascular complication after deceased donor liver transplantation (DDLT) that has been reported to occur up to 2% of recipients in a posttransplant period. This may be caused by direct instrumentation of the IVC stenosis at the anastomotic site, haematoma, and rarely by a twist in the retrohepatic IVC. The location of the thrombus, the timing after the surgery, and associated hemodynamic disturbances define the outcome of the patient. Without prompt diagnosis and timely intervention, the outcome after IVC thrombosis is usually dismal. Herein, we report a rare case of near-complete occlusion of the IVC secondary to intracaval thrombosis after DDLT associated with twisting of the IVC at the suprahepatic anastomosis which was successfully managed by intravascular thrombolysis and stenting.

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“…Various reports on stenosis of the IVC as a complication after LDLT have been published. The main causes are considered to be displacement due to ascites retained near the graft in the early stage and deflection accompanied by graft enlargement in the middle to late stages . Symptoms include intractable ascites, edema in the lower extremities, and abdominal pain, sometimes accompanied by hepatic dysfunction and graft dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…Symptoms include intractable ascites, edema in the lower extremities, and abdominal pain, sometimes accompanied by hepatic dysfunction and graft dysfunction. Stenosis occurs regardless of the type of graft, and brain death and LDLT were also reported . Stenosis is diagnosed when IVC venography visualizes the stenosis site and shows a difference in pressure gradient of at least 5 mm Hg between the cranial part and the caudal part of the IVC.…”

Section: Discussionmentioning

confidence: 99%

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IVC angioplasty using an autologous vascular graft for IVC stenosis due to metallic stent in a pediatric liver transplant

Kosaka

Eguchi

Hidaka

et al. 2019

Pediatric Transplantation

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A 12‐year‐old girl underwent LDLT using a left lobe graft for hepatic dysfunction associated with citrin deficiency. A continuous anastomosis suture technique was performed between the recipient's IVC and the donor's left hepatic vein. At age 14, the patient developed intractable ascites. Venography of the IVC and hepatic vein showed twisted‐shape stenosis of the hepatic vein‐IVC anastomosis with intravascular pressure gradient, probably due to the enlarged transplanted liver, for which a metallic stent was placed. The ascites disappeared, and the patient was making satisfactory progress eight months after surgery. However, nine months after surgery, the ascites appeared again with edema in the lower extremities. Since the stent that had been inserted was suspected of hampering the outflow of the graft liver and IVC, it was decided to conduct stent removal and IVC angioplasty. After intravascular exploration, the stent was removed. Angioplasty was performed. An autologous vascular graft patch was designed to be wedge‐shaped to fit the incised part of the IVC, and it was sutured with 5‐0 non‐absorbable surgical sutures using a continuous suture technique. No postoperative complications or perioperative graft dysfunction were observed. The ascites decreased markedly, and the edema in the lower extremities disappeared. Thus, we were able to successfully perform IVC angioplasty using an autologous vascular graft patch in a patient who developed IVC stenosis after stenting. This procedure is one of the most effective treatment options, especially for pediatric patients requiring long‐term vascular patency.

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Inferior Vena Cava Torsion and Stenosis Complicated by Compressive Pericaval Regional Ascites following Orthotopic Liver Transplantation

Cited by 3 publications

References 11 publications

A Comprehensive Approach to Hepatic Vascular Disease

A Comprehensive Approach to Hepatic Vascular Disease

Intravascular Thrombolysis Followed by Stenting as Management of Retrohepatic Inferior Vena Caval Thrombosis due to a Twist in the Inferior Vena Cava after Deceased Donor Liver Transplant

IVC angioplasty using an autologous vascular graft for IVC stenosis due to metallic stent in a pediatric liver transplant

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