Use of autologous radial artery for revascularization of hepatic artery thrombosis after orthotopic liver transplantation: Case report and review of indications and options for urgent hepatic artery reconstruction

Abstract

Hepatic artery thrombosis (HAT) is the most common vascular complication after orthotopic liver transplantation (OLT) and has traditionally been managed with re-OLT. However, several reports have shown that urgent revascularization is frequently an effective means of graft salvage. This most often involves hepatic artery (HA) thrombectomy and thrombolysis, with reestablishment of arterial inflow through a donor iliac artery conduit based on the supraceliac or infrarenal aorta. We report a 46-year-old man who developed HAT 13 days after OLT after angiographic splenic artery embolization to reduce splenic artery steal. A suitable donor iliac artery was not available for arterial reconstruction and could not be obtained from neighboring transplant centers. The patient underwent urgent HA thrombectomy, intrahepatic arterial thrombolysis, and revascularization using an autologous radial artery (RA) conduit based on the supraceliac aorta. The patient is alive more than 1 year after revascularization, with normal liver function and documented flow in the arterial conduit by Doppler ultrasound and arteriography. He has not developed late biliary complications or adverse sequelae of RA harvest. Autologous RA can be safely and successfully used as an aortic-based arterial conduit in urgent revascularization of HAT after OLT. RA should be considered for use in HA revascularization if an adequate donor iliac artery is not available and other potential conduits are not usable or desirable. The availability of autologous RA expands the armamentarium of vascular conduits that can be used in HA revascularization and may help minimize re-OLT for otherwise potentially salvageable liver allografts. (Liver Transpl 2001;7:913-917.) H epatic artery (HA) thrombosis (HAT) is the most common vascular complication in orthotopic liver transplantation (OLT), with an incidence of 2% to 5% in adults and 10% to 33% in children. 1 Although interruption of HA flow is frequently well tolerated in a native liver because of the presence of collateral arterial blood supply, it is often a morbid and life-threatening event after OLT because of the lack of collateral vessels. Although it has been speculated that as many as one third of all early cases of HAT after OLT may be asymptomatic, 2 many episodes of HAT result in either acute hepatic necrosis and liver failure or late biloma and hepatic abscess formation. Traditionally, HAT has been considered an indication for urgent re-OLT, and most cases are still managed in this way. Although re-OLT has significantly reduced the morbidity and mortality attributable to HAT, this option has become limited by the decreasing availability of organs for transplantation. Over the past decade, several reports have shown the effectiveness of urgent revascularization for early HAT. [2][3][4][5][6] Although HA thrombectomy with primary reanastomosis is well described, revascularization usually requires the use of a donor iliac artery as a vascular conduit between the aorta and allograft HA.We report a novel approach ...

Early Hepatic Artery Thrombosis after Liver Transplantation: A Systematic Review of the Incidence, Outcome and Risk Factors

“…Nishida et al report a clear and significant relation to urgent revascularization after eHAT and a better outcome in terms of morbidity and mortality (59). Urgent revascularization has been described by others as a useful treatment option for early HAT (4,16,45,46,84,85,(115)(116)(117). In conclusion, early detection and thus more frequent screening in the early postoperative period might contribute to a better outcome.…”

“…For this review, we found only two publications dealing with the issue of whole versus reduced size grafting (55,64 (28,42,73,76,90,(104)(105)(106)(107)(108) (59). Urgent revascularization has been described by others as a useful treatment option for early HAT (4,16,45,46,84,85,(115)(116)(117) (Figure 2). …”

Implantable sensor for blood flow monitoring after transplant surgery

“…These complications include hepatic artery thrombosis (HAT) and stenosis (HAS), portal vein thrombosis (PVT), deep vein thrombosis (DVT), hemorrhage, and arteriovenous ®stulas [2]. HAT is the most common post-transplant complication occurring in 3-12% of adult recipients and up to 42% of pediatric patients, often requiring urgent re-transplantation [3,4]. The frequency of HAT in pediatric liver transplants has decreased due to modi®cations of the technique of arterial anastomosis, but it continues to be problematic.…”

Use of donor aorta for arterial reconstruction in paediatric liver and multivisceral transplantation

“…Arterial reconstruction depends on the anatomy and size of the donor and recipient vessels. Various surgical techniques for reconstruction of the hepatic artery have been described6–13. The vessels are usually small and friable, and various interposition grafts have been employed, including iliac artery, splenic artery, superior mesenteric artery, autologous radial artery and saphenous vein6–13.…”