Vascular complications after liver transplantation

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

“…Compared to arterial complications, venous compli cations are less frequent with an estimated overall incidence of less than 3% [4,5,8,9,62,8991] . They can be potentially devastating and lead to graft failure, and therefore represent an important source of morbidity and mortality after OLT, especially if they occur in the early postoperative period [9,90,91] .…”

“…Venous complications following OLT include: Portal (1%-3%) and caval (< 2%) problems [5,8,9,91] . The etiology underlying most of these involves the anastomosis, including: (1) PVT: < 3% (the most pejorative), portal vein stenosis (PVS): 2%-3%; and (2) caval and hepatic veins with specific complications depending to the type of anastomosis either end to end caval anastomosis: Thrombosis, stenosis (< 2%); or piggyback: Thrombosis, stenosis, kinking < 2% [4,5,8,9,91,94,95] . In the same fashion as HACs, they can be classified into two categories (Table 1): Early (< 1 mo) or late (delayed, i.e., > 1 mo).…”

“…The incidence of portal vein complications (PVCs) following liver transplantation is relatively uncommon, occurring in 1% to 3% of patients [4,5,8,9,8991,96] . These complications are associated with high morbidity and graft loss [8,9] .…”

“…Clinical presentation ranges from lower limb edema, hepatomegaly, ascites, pleural effusions, BuddChiari syndrome, liver and renal failure to hypotension leading to allograft loss and multiorgan failure [4,89,135] . The main risk factor leading to caval anastomosis complications (CACs) is represented by technical errors in the connection of caval anastomoses, which lead to kinking or thrombosis in the early postoperative course.…”

Evaluation of the hepatic artery anastomosis by intraoperative sonography with high‐frequency transducer in right‐lobe graft living donor liver transplantation

“…The most problematic vascular complications are those of the hepatic artery (HA) because insufficient HA inflow may result in graft ischemia or failure or such acute biliary complications as bile duct necrosis, bile leak, and biliary sepsis. 1 The role of Doppler sonography (US) as a screening modality cannot be overemphasized in the noninvasive evaluation of the graft HA flow, and a unique advantage of this method is that it can be performed intraoperatively, providing an immediate assessment of the vascular patency so that the surgeon has an opportunity to decide on a timely and appropriate management. [2][3][4] Previous reports using intraoperative sonography (IOUS) showed that the patency of the HA anastomosis could be determined by quantitative and qualitative assessment of Doppler signals from the graft HA that reflect hemodynamic changes across the anastomosis.…”