[Arterial steal syndrome in patients after liver transplantation: transarterial embolization of the splenic and gastroduodenal arteries].
Arterial steal syndrome in patients after liver transplantation: transarterial embolization of the splenic and gastroduodenal arteries.


OBJECTIVE
To evaluate transarterial embolization of splenohepatic and gastroduodenal steal syndrome in patients with impaired liver function tests after liver transplantation.


METHODS
In a prospective study 22 patients (10 male, 12 female; mean age 49.5 years) with unexplained elevation of hepatic enzymes after liver transplantation underwent transcatheter arterial embolization of splenohepatic (n = 18) and gastroduodenal (n = 4) steal syndrome with use of Gianturco coils or microcoils. Liver and spleen parenchyma were surveyed and evaluated before and after embolization with plain helical CT, including volumetry of liver and spleen.


RESULTS
DSA examinations revealed a dilated splenic artery (n = 18) or gastroduodenal artery (n = 4) combined with a slightly decreased perfusion of the hepatic arteries, while immediately after successful embolization a normal perfusion of the hepatic arteries could be noted. Volumetric measurements before and after embolization showed no significant changes in liver parenchyma (x = + 7 % +/- 2), and variable changes in splenic volume of -5 % to + 28 % (mean, + 11 %), with initial measurements. Clinical follow-up examinations revealed a normalization of the previously elevated hepatic enzymes and a normalization of liver function tests after successful embolization. Complications were observed in 4 patients (infarction of the spleen).


CONCLUSIONS
The preliminary results reveal that in liver transplant candidates with splenohepatic and gastroduodenal steal syndrome successful embolization results in an improvement of organ perfusion with normalization of function tests.
Vogl
T J
TJ
Institut für Diagnostische und Interventionelle Radiologie Johann Wolfgang Goethe Universität, Frankfurt am Main, Germany. puls@charite.de
Pegios
W
W
Balzer
J O
JO
Lobo
M
M
Neuhaus
P
P
D000328:Adult; D000368:Aged; D000792:Angiography; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000628:therapy; D004386:Duodenum / Q000098:blood supply; D004621:Embolization, Therapeutic; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000628:therapy*; D008099:Liver / Q000098:blood supply*; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D013157:Splenic Artery / Q000000981:diagnostic imaging; D013270:Stomach / Q000098:blood supply; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome