Interventional radiology in the management of complications after liver transplantation

Abstract

The arrival of new surgical transplantation techniques, such as split living donor or auxiliary liver transplantation, have increased the incidence of vascular and biliary complications. The causes, symptoms, and diagnostic modalities of arterial, portal caval, and biliary complications are detailed. Interventional techniques, such as balloon angioplasty and stent placement in the arterial and portal tree, as well as biliary interventional techniques, are discussed.

Endovascular treatment of acute arterial complications after living-donor liver transplantation

“…2,4 However, catheter-directed thrombolysis for early hepatic artery thrombosis has been attempted for several decades, and successful results with graft salvage have been reported. 6,9 In spite of the small population, the 5% incidence of hepatic artery thrombosis in the present study was similar to the results of previous reports, 2.5e6%, 2,4,13 and two of four patients were successfully recanalized by thrombolysis. In these patients, biliary stricture developed 5 and 7 months after LDLT.…”

Palliative Portal Vein Stent Placement in Malignant and Symptomatic Extrinsic Portal Vein Stenosis or Occlusion

“…Procedures PV stent placement has been described with a surgical approach via an ileal or jejunal vein [3,13,21,24,25] or a transjugular intrahepatic portosystemic shunt-type approach [4,11,18]. Nevertheless, as in our study, a transhepatic route has been most often used in the past with a very low rate of hemorrhagic complications [5, 6, 14-17, 20-22, 26].…”

“…Afterward, PV pressures were measured across the stenotic lesions by using a device (Eagle 3000, Hellige, Milwaukee, WI) connected to a monitor (Edwards Lifesciences, Irvine, CA). A pressure gradient across the stenosis was calculated and was assumed significant if it was C5 mmHg, as it is the case for PV stenosis in hepatic transplants [24]. The stenotic lesions were dilated with a balloon catheter 4 cm in length and 10 mm in diameter (Powerflex, Cordis endovascular, Roden, The Netherlands).…”

“…An effective treatment was assumed when control venography showed rapid flow through the PV with absence of flow in the previously observed collaterals. A pressure gradient of 3 mmHg or less was considered a technical success as is the case for treatment of PV stenosis in hepatic transplants [24]. Finally, the sheath was replaced by a 5-F 20-cm catheter, and one to three 5-mm in diameter coils (Cook, Bjaeverskov, Denmark) were placed in the liver parenchyma tract through this catheter while it was withdrawn.…”

The role of interventional radiology in complications after paediatric liver transplantation

“…[1] A multidisciplinary approach to the post-transplant patient is vital, and image-guided, minimally invasive procedures improve graft and patient survival. [2] …”