Surgical and endovascular treatment of hepatic arterial complications following liver transplant

Abstract

Vascular complications after liver transplantation increase post-operative morbidity and contribute to the incidence of retransplantation. Vascular complications comprise arterial, caval, and portal venous pathology, with the majority of complications being arterial in etiology, including anastomotic stricture, pseudoaneurysm, and thrombosis. There are two major therapeutic options for the treatment of these arterial complications: endovascular intervention and surgery. The former includes intra-arterial thrombolysis, embolization, percutaneous transluminal angioplasty, and stent placement. The latter includes thrombectomy, reanastomosis, and retransplantation. Although surgical treatment has been considered the first choice for management in the past, advances in endovascular intervention have increased and make it a viable therapeutic option following orthotopic liver transplantation. This review focuses on the role of surgical and endovascular therapy in the management of hepatic arterial complications after liver transplantation.

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

“…Most of the authors have defined late complications as those occurring after 4 wk, and others after 6 mo [13,25,27,28] . In this review, we consider the recent consensus which defines early complication when it appears within the first month [10,13,18,27,28] .…”

Reducing the incidence of hepatic artery thrombosis in pediatric liver transplantation: Effect of microvascular techniques and a customized anticoagulation protocol

“…Patients with chronic liver disease have decreased levels of both pro‐coagulant factors as well as naturally occurring anticoagulants such as antithrombin 3, protein C and S, as almost all factors responsible for hemostasis are produced in the liver . This then makes patients susceptible to bleeding but also paradoxically to vascular thrombosis as well.…”

“…[14][15][16][17] Patients with chronic liver disease have decreased levels of both pro-coagulant factors as well as naturally occurring anticoagulants such as antithrombin 3, protein C and S, as almost all factors responsible for hemostasis are produced in the liver. 6,[18][19][20] This then makes patients susceptible to bleeding but also paradoxically to vascular thrombosis as well. In the immediate post-transplant period, this risk is amplified due to a lag in the production of AT3, protein C and S by the transplanted liver, placing the patient at greater risk of vascular thrombosis.…”

Interventional radiology in the management of the liver transplant patient

“…(1)(2)(3)(4) The development of HAS is associated with allograft rejection, microvascular injury from cold preservation of the liver, disruption of the vasa vasorum, clamp injury, caliber size mismatch, prior transarterial chemoembolization (TACE), extrinsic compression, and technical issues. (5) Patients with HAS typically present with graft dysfunction or biliary complications, but a stenosis may be subclinical in up to 20% of patients, which emphasizes the importance of close laboratory and imaging surveillance. (6,7) Additionally, early diagnosis of HAS is critical because delay has been shown to increase the severity of biliary complications and the chance of graft loss.…”