Color Doppler sonography in the diagnosis and monitoring of arterial complications after liver transplantation.
OBJECTIVE
We assessed the usefulness of color Doppler imaging in the diagnosis and monitoring of arterial complications after liver transplantation.


METHODS
Subjects were 142 liver transplant recipients who underwent serial color Doppler sonographic evaluations of the hepatic arteries after surgery. Patients with abnormal sonographic findings underwent subsequent angiography.


RESULTS
Eighteen subjects experienced 20 hepatic arterial complications (13 thromboses and 7 stenoses). In 7 of the 13 thrombosis incidents, hepatic arterial obstruction occurred within a month of surgery and was evident from the absence of Doppler signals; angiography confirmed the absence of hepatic arterial perfusion in these cases. In the other 6 thrombosis cases, the thrombosis developed 3 or more months after surgery and became apparent from the absence of color Doppler signals at the level of the main arterial trunk and the presence of intraparenchymal "tardus parvus" waveforms. In these cases, angiography showed obstruction of the main arterial trunk and the development of compensatory collateral vessels. In 3 of the 7 cases of stenosis, high flow velocities were recorded at the site of the narrowing, and intrahepatic tardus parvus waveforms were present. In the other 4 stenosis cases, the site of stenosis could not be identified, but intraparenchymal tardus parvus waveforms were recorded.


CONCLUSIONS
The use of color Doppler sonography allows the early diagnosis of hepatic arterial complications after liver transplantation. Tardus parvus waveforms indicated severe impairment of hepatic arterial perfusion, from either thrombosis or severe stenosis. The presence of these waveforms enhanced the accuracy of color Doppler diagnosis (100% positive predictive value), and their detection should prompt angiography.
De Gaetano
A M
AM
Department of Radiology, Policlinico Agostino Gemelli, Catholic University, Largo Agostino Gemelli 8, 00168 Rome, Italy.
Cotroneo
A R
AR
Maresca
G
G
Di Stasi
C
C
Evangelisti
R
R
Gui
B
B
Agnes
S
S
D000328:Adult; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology; D018615:Ultrasonography, Doppler, Color