Use of autologous radial artery for revascularization of hepatic artery thrombosis after orthotopic liver transplantation: case report and review of indications and options for urgent hepatic artery reconstruction.
Hepatic artery thrombosis (HAT) is the most common vascular complication after orthotopic liver transplantation (OLT) and has traditionally been managed with re-OLT. However, several reports have shown that urgent revascularization is frequently an effective means of graft salvage. This most often involves hepatic artery (HA) thrombectomy and thrombolysis, with reestablishment of arterial inflow through a donor iliac artery conduit based on the supraceliac or infrarenal aorta. We report a 46-year-old man who developed HAT 13 days after OLT after angiographic splenic artery embolization to reduce splenic artery steal. A suitable donor iliac artery was not available for arterial reconstruction and could not be obtained from neighboring transplant centers. The patient underwent urgent HA thrombectomy, intrahepatic arterial thrombolysis, and revascularization using an autologous radial artery (RA) conduit based on the supraceliac aorta. The patient is alive more than 1 year after revascularization, with normal liver function and documented flow in the arterial conduit by Doppler ultrasound and arteriography. He has not developed late biliary complications or adverse sequelae of RA harvest. Autologous RA can be safely and successfully used as an aortic-based arterial conduit in urgent revascularization of HAT after OLT. RA should be considered for use in HA revascularization if an adequate donor iliac artery is not available and other potential conduits are not usable or desirable. The availability of autologous RA expands the armamentarium of vascular conduits that can be used in HA revascularization and may help minimize re-OLT for otherwise potentially salvageable liver allografts.
Rogers
J
J
Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA. rogersje@musc.edu
Chavin
K D
KD
Kratz
J M
JM
Mohamed
H K
HK
Lin
A
A
Baillie
G M
GM
Shafizadeh
S F
SF
Baliga
P K
PK
D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D006499:Hepatic Artery; D006801:Humans; D008102:Liver Circulation / Q000502:physiology*; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000637:transplantation*; D012086:Reoperation; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014654:Vascular Patency