Endovascular management of early hepatic artery thrombosis after living donor liver transplantation

To study the feasibility of endovascular management of early hepatic artery thrombosis (HAT) after living‐donor liver transplantation (LDLT) and to clarify its role as a less invasive alternative to open surgery. A retrospective review of 360 recipients who underwent LDLT. Early HAT developed in 13 cases (3.6%). Diagnosis was performed using Doppler, CT angiography, and digital subtraction angiography. Intra‐arterial thrombolysis (IAT) was performed using streptokinase or tPA. In case of underlying stricture, PTA was attempted. If the artery did not recanalize, continuous infusion was performed and monitored using Doppler US. Initial surgical revascularization was successful in 2/13 cases. IAT was performed in 11/13 cases. The initial success rate was 81.8% (9/11), the failure rate was 18.2% (2/11). Rebound thrombosis developed in 33.3% (3/9). Hemorrhage developed after IAT in 2/11 cases (18.2%). Definite endovascular treatment of HAT was achieved in 6/11 cases (54.5%) and definite treatment (surgical, endovascular or combined) in 9/13 cases (69%). (Follow‐up 4 months–4 years). Endovascular management of early HAT after LDLT is a feasible and reliable alternative to open surgery. It plays a role as a less invasive approach with definite endovascular treatment rate of 54.5%.

[1]  C. Ribera,et al.  Recipient and donor thrombophilia and the risk of portal venous thrombosis and hepatic artery thrombosis in liver recipients , 2011, BMC gastroenterology.

[2]  C. Sabin,et al.  Risk factors associated with early hepatic artery thrombosis after orthotopic liver transplantation – univariable
and multivariable analysis , 2011, Transplant international : official journal of the European Society for Organ Transplantation.

[3]  A. Geerts,et al.  Early arterial revascularization after hepatic artery thrombosis may avoid graft loss and improve outcomes in adult liver transplantation. , 2010, Transplantation proceedings.

[4]  A. Singhal,et al.  Endovascular treatment of hepatic artery thrombosis following liver transplantation , 2010, Transplant international : official journal of the European Society for Organ Transplantation.

[5]  Shu-sen Zheng,et al.  Microsurgical reconstruction of hepatic artery in living donor liver transplantation: experiences and lessons. , 2009, Hepatobiliary & pancreatic diseases international : HBPD INT.

[6]  A. S. Lima,et al.  Splenic artery steal syndrome after liver transplantation: an alternative technique of embolization. , 2009, Transplantation proceedings.

[7]  Johnny C. Hong,et al.  Vascular complications of orthotopic liver transplantation: experience in more than 4,200 patients. , 2009, Journal of the American College of Surgeons.

[8]  K. Tanaka,et al.  Crucial issues of hepatic artery reconstruction in living donor liver transplantation: our experience with 133 cases at Dar El-Fouad Hospital, Egypt. , 2009, Journal of reconstructive microsurgery.

[9]  K. D. de Jong,et al.  Early Hepatic Artery Thrombosis after Liver Transplantation: A Systematic Review of the Incidence, Outcome and Risk Factors , 2009, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[10]  C. Viana,et al.  Continuous versus interrupted suture for hepatic artery anastomosis in liver transplantation: differences in the incidence of hepatic artery thrombosis. , 2008, Transplantation proceedings.

[11]  H. Shan,et al.  Hepatic artery complications after orthotopic liver transplantation: interventional treatment or retransplantation? , 2008, Chinese medical journal.

[12]  S. Miyagi,et al.  Microsurgical back wall support suture technique with double needle sutures on hepatic artery reconstruction in living donor liver transplantation. , 2008, Transplantation proceedings.

[13]  G. Engelmann,et al.  Successful arterial thrombolysis and percutaneous transluminal angioplasty for early hepatic artery thrombosis after split liver transplantation in a four‐month‐old baby , 2008, Pediatric transplantation.

[14]  K. Takeda,et al.  Stent-Graft for the Management of Hepatic Artery Rupture Subsequent to Transcatheter Thrombolysis and Angioplasty in a Liver Transplant Recipient , 2008, CardioVascular and Interventional Radiology.

[15]  L. Saba,et al.  Multidetector row CT angiography in the evaluation of the hepatic artery and its anatomical variants. , 2008, Clinical radiology.

[16]  M. Haberal,et al.  Accuracy of multidetector computed tomographic angiography for detecting hepatic artery complications after liver transplantation. , 2007, Transplantation proceedings.

[17]  N. Toyota,et al.  Splenic artery steal syndrome in living donor liver transplantation: a case report. , 2007, Transplantation proceedings.

[18]  Zhi-qiang Huang,et al.  Interventional treatment of acute hepatic artery occlusion after liver transplantation. , 2007, Hepatobiliary & pancreatic diseases international : HBPD INT.

[19]  M. Davies,et al.  Catheter Thrombolysis of Thrombosed Hepatic Arteries in Liver Transplant Recipients: Predictors of Success and Role of Thrombolysis , 2007, Vascular and endovascular surgery.

[20]  H. Karakayalı,et al.  Arterial steal syndrome after orthotopic liver transplantation. , 2006, Transplantation proceedings.

[21]  B. Kim,et al.  Intraarterial thrombolytic treatment for hepatic artery thrombosis immediately after living donor liver transplantation. , 2006, Transplantation proceedings.

[22]  Z. Wang,et al.  Continuous transcatheter arterial thrombolysis for early hepatic artery thrombosis after liver transplantation. , 2005, Transplantation proceedings.

[23]  Shu-sen Zheng,et al.  Prevention and treatment of hepatic artery thrombosis after liver transplantation. , 2004, Hepatobiliary & pancreatic diseases international : HBPD INT.

[24]  H. Karakayalı,et al.  Diagnostic and therapeutic management of hepatic artery thrombosis and stenosis after orthotopic and heterotopic liver transplantation. , 2003, Transplantation proceedings.

[25]  U. Settmacher,et al.  Hepatic artery thrombosis after adult liver transplantation , 2003, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[26]  U. Settmacher,et al.  Diagnosis and treatment of arterial steal syndromes in liver transplant recipients , 2003, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[27]  K. Dudek,et al.  Vascular complications after liver transplantation. , 2003, Transplantation proceedings.

[28]  T. Berney,et al.  Effect of protocol Doppler ultrasonography and urgent revascularization on early hepatic artery thrombosis after pediatric liver transplantation. , 2002, Archives of surgery.

[29]  R. Uflacker,et al.  Transcatheter Splenic Artery Occlusion for Treatment of Splenic Artery Steal Syndrome After Orthotopic Liver Transplantation , 2002, CardioVascular and Interventional Radiology.

[30]  P. Neuhaus,et al.  Arterielles Steal-Syndrom bei Patienten nach Lebertransplantation: Transarterielle Embolisation von A. lienalis oder A. gastroduodenalis , 2001 .

[31]  J. Neuberger,et al.  Delayed hepatic artery thrombosis in adult orthotopic liver transplantation-a 12-year experience. , 2001, Transplantation.

[32]  E. Moreno gonzález,et al.  [Assessment of risk factors in the incidence of hepatic artery thrombosis in a consecutive series of 687 liver transplantations]. , 2001, Annali italiani di chirurgia.

[33]  U. Settmacher,et al.  Aneurysms of the hepatic artery after liver transplantation. , 2000, Transplantation proceedings.

[34]  T. Matalon,et al.  Alteplase as an Alternative to Urokinase , 2000 .

[35]  R. Shapira,et al.  Hepatic artery thrombosis in pediatric liver transplantation: Graft salvage after thrombectomy , 1999, Pediatric transplantation.

[36]  T. Starzl,et al.  Urgent revascularization of liver allografts after early hepatic artery thrombosis. , 1996, Transplantation.

[37]  I. Sproat,et al.  Hepatic artery thrombosis after liver transplantation: temporal accuracy of diagnosis with duplex US and the syndrome of impending thrombosis. , 1996, Radiology.

[38]  J. Figueras,et al.  Intra-arterial thrombolysis in the treatment of acute hepatic artery thrombosis after liver transplantation. , 1995, Transplantation.

[39]  P. Parrilla,et al.  Hepatic artery complications after liver transplantation. , 1994, Clinical transplantation.

[40]  M. Langer,et al.  [The splenic steal syndrome and the gastroduodenal steal syndrome in patients before and after liver transplantation]. , 1992, Aktuelle Radiologie.

[41]  R. Stratta,et al.  Vascular complications following orthotopic liver transplantation: outcome and the role of urgent revascularization. , 1991, Transplantation proceedings.

[42]  C. Herfarth,et al.  Arterial steal: an unusual cause for hepatic hypoperfusion after liver transplantation , 1991, Transplant international : official journal of the European Society for Organ Transplantation.

[43]  J. Abad,et al.  High-dose intra-arterial urokinase for the treatment of hepatic artery thrombosis in liver transplantation. , 1989, Hepato-gastroenterology.

[44]  H. Karakayalı,et al.  Endovascular stent placement in patients with hepatic artery stenoses or thromboses after liver transplant. , 2008, Transplantation proceedings.

[45]  W. Pegios,et al.  [Arterial steal syndrome in patients after liver transplantation: transarterial embolization of the splenic and gastroduodenal arteries]. , 2001, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[46]  C. Rossi,et al.  Treatment of vascular complications following liver transplantation: multidisciplinary approach. , 2001, Hepato-gastroenterology.

[47]  M. Colombo,et al.  Nonpercutaneous therapies of hepatocellular carcinoma. , 2001, Hepato-gastroenterology.

[48]  T. Inomoto,et al.  Experiences of 120 microsurgical reconstructions of hepatic artery in living related liver transplantation. , 1996, Surgery.

[49]  D. C. Henckel,et al.  Case report. , 1995, Journal.

[50]  R. Stratta,et al.  Hepatic allograft rescue following arterial thrombosis. Role of urgent revascularization. , 1991, Transplantation.