Vascular complications in living related liver transplantation detected with intraoperative and postoperative Doppler US

Someda, Hitoshi; Moriyasu, Fuminori; Fujimoto, Masazumi; Hamato, Noriyuki; Nabeshima, Motoshige; Nishikawa, Koji; Okuma, Minoru; Tanaka, Kōichi; Ozawa, Kazue

doi:10.1016/0168-8278(95)80218-5

Cited by 105 publications

(56 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It has been demonstrated that the portal venous size and flow velocity correlated directly with the portal flow volume. In our experience, the mean velocity of the portal flow was 38.63 f 8.31 cm/s and the portal blood flow volume per body weight was 22.54 f 8.27 ml/min per kg in non-complicated vascular patients, with 9 ml/min per kg being defined as the lowest limit of acceptable portal flow volume during and after transplantation [5,15]. In cases where low portal inflow is associated with suspected portal hypertension syndrome, angiographic hemodynamic confirmation or indirect pressure gradient measurement (hepatic wedge and splenic direct pulp pressure) is indicated [13].…”

Section: Discussionmentioning

confidence: 99%

Interventional radiologic procedures in liver transplantation

Cheng¹,

Huang²,

Chen³

et al. 2001

Transplant Int

View full text Add to dashboard Cite

Postoperative biliary and vascular complications contribute significantly to morbidity and mortality in liver transplantation. Interventional radiologists are an integral part of the multidisciplinary team necessary for optimizing the management of these complications. During a 15-year period, 39 cadaveric and 25 living related liver transplantations were performed at the Chang Gung Memorial hospital, Taiwan. Of 64 liver transplant recipients, 9 (3 adult and 6 pediatric) underwent 13 interventional radiological procedures for the treatment of biliary sludge-casts (n = 2), bile duct occlusion or stenosis ( n = 2), hepatic veins thrombosis (n = l), hepatic veins stenosis ( n = l), portal vein stenosis with splenorenal shunting (n = l), biloma (n = l), and infected fluid collection or ascites (n = 4). Antegrade or retrograde interventional approach was used to successfully treat all biliary complications, and all percutaneous drainage procedures were effective in the control of intra-abdominal fluid collections. Portal vein stenosis was treated by balloon dilatation, and the associated splenorenal shunt was closed by metallic coil embolization via transhepatic catheterization of the portal vein. Hepatic vein stenosis was effectively treated by balloon dilatation and expandable metallic stent deployment via transfemoral and jugular venous approaches, respectively. Hepatic vein thrombosis was only partially lysed by transvenous streptokinase administration, and surgical thrombectomy was needed to achieve complete recanalization. The total success rate of the interventional procedures was 92 % with no procedure-related complications. The overall survival rate in this series is 89 %, and all patients who underwent living related liver transplantation maintain to date a 100 YO survival rate. We can conclude that interventional radiological procedures are very useful for managing biliary and vascular complications after liver transplantation. These techniques provide a cure in most situations, thus obviating the need for further surgical intervention or re-transplantation.

show abstract

Section: Discussionmentioning

confidence: 99%

Interventional radiologic procedures in liver transplantation

Cheng¹,

Huang²,

Chen³

et al. 2001

Transplant Int

View full text Add to dashboard Cite

show abstract

“…Reported incidences of hepatic venous outflow occlusion following LDLT range from 3.9% to 16.6%. 3,[15][16][17] In LDLT recipients, early posttransplant hepatic venous occlusion may induce liver function deterioration, graft failure, or death because of the graft's size insufficiency. 1,18 Thus, early adequate treatment of hepatic venous outflow occlusion is important for good graft function.…”

Section: Discussionmentioning

confidence: 99%

Early posttransplant hepatic venous outflow obstruction: Long-term efficacy of primary stent placement

et al. 2008

View full text Add to dashboard Cite

Although balloon angioplasty has been accepted as the safe and effective initial treatment to manage hepatic venous outflow abnormalities, it may induce rupture of the fresh anastomosis but also may be ineffective to eliminate various etiologies of venous outflow abnormalities in the early post-transplant period. Therefore, we performed primary stent placement in 108 patients to treat early-onset (Յ4 weeks) post-transplant hepatic venous outflow abnormality. The following parameters were documented retrospectively: technical success and complications: clinical success; recurrence; and patency of stent-inserted hepatic veins.Technical success was achieved in 166 (97.6%) of 170 anastomoses (107 patients). Major complications occurred in 5 (4.6%) patients: partial stent migration (n ϭ 2) and stent malposition (n ϭ 3). Clinical success was achieved in 83 (82.2%) of 101 patients who had abnormal liver enzymes or clinical symptoms. Seven patients without initial clinical symptoms have remained healthy. Restenosis or occlusion of the stent-inserted hepatic veins was documented in 22 patients at a mean of 9.6 Ϯ 8.6 months after stent placement. Four of them underwent stent replacement or retransplantation due to liver function deterioration. Overall 1-, 3-, and 5-year primary patency rates were 82.3 Ϯ 0.3%, 75.0 Ϯ 0.4%, and 72.4 Ϯ 0.5%, respectively. Multivariate Cox regression analysis showed that diameter of stents was an independent factor associated with patency of stents (p ϭ 0.001).Primary stent placement seems to be an effective treatment modality with an acceptable long-term patency to treat early post-transplant hepatic venous outflow obstruction. Liver Transpl 14: 1505-1511, 2008.

show abstract

“…Color Doppler ultrasonography has been used with humans as a noninvasive technique for real time diagnoses of aberrant blood flow (Someda et al, 1995;Whelan and Barry, 1992), stenosis (Hatle et al, 1980;Olin et al, 1995;Schmidt et al, 1997), and occlusions (Moneta et al, 1992;Müller et al, 1995). It also has been used to determine vasoconstrictive and blood flow responses in cattle (Aiken et al, 2007; and sheep (Aiken et al, 2011) to ergot alkaloids, and was performed with steers to quantify artery lumen area and blood flow responses to heat and cold challenges (Kirch et al, 2008).…”

Section: Wwwintechopencommentioning

confidence: 99%