title: Thrombolysis and endovascular stent placement for inferior vena caval thrombosis in a liver transplant recipient.
abstract: BACKGROUND
  Vascular complications remain an important cause of postoperative morbidity in liver transplant patients. Herein, we present an unusual case of nonanastomotic inferior vena cava (IVC) stenosis in a patient with a "piggyback" caval anastomosis.
  
  
  METHODS
  A 59-year-old woman underwent liver transplantation using a piggyback IVC anastomosis. Her postoperative course was complicated by IVC thrombosis. Catheter-directed thrombolysis, followed by balloon angioplasty and intravascular stent placement, was used to recanalize the IVC and treat a severe retrohepatic IVC stenosis.
  
  
  RESULTS
  After 46 hr of catheter-directed urokinase infusion, there was clot lysis and identification of a severe stenosis in the retrohepatic IVC. The lesion was extremely resistant to balloon dilatation alone and a 22-mm-diameter intravascular stent was placed. Simultaneous dilatation of three high-pressure balloons was necessary for maximal stent expansion. The patient remains asymptomatic with no evidence of IVC compromise through 20 months of follow-up.
  
  
  CONCLUSIONS
  IVC stenosis and thrombosis after liver transplantation may be treated favorably in some patients using catheter-directed thrombolytic therapy followed by balloon dilatation and/or stent placement.
authors.affiliation: Department of Radiology, University of Pittsburgh Medical Center, Pennsylvania 15213, USA. orons@pop.pitt.edu
authors.forename: P D
authors.initials: PD
authors.lastname: Orons
authors.forename: A K
authors.initials: AK
authors.lastname: Hari
authors.forename: A B
authors.initials: AB
authors.lastname: Zajko
authors.forename: J W
authors.initials: JW
authors.lastname: Marsh
mesh_terms: D000800:Angioplasty, Balloon / Q000379:methods*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D015607:Stents; D015912:Thrombolytic Therapy / Q000379:methods*; D013924:Thrombophlebitis / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*; D014682:Vena Cava, Inferior / Q000601:surgery*
chemical_list: D014568:Urokinase-Type Plasminogen Activator