[Interventional radiological techniques in management of early hepatic artery thrombosis after liver transplantation].
OBJECTIVE
To evaluate the safety and efficacy of interventional radiological techniques in management of early hepatic artery thrombosis (HAT) after orthotopic liver transplantation (OLT).


METHODS
Nine patients with HAT after OLT, 8 males and 1 female, aged 47.6 (32-63), presenting elevation of liver enzymes and bilirubin, whose diagnosis was suggested by Doppler ultrasonography and confirmed by angiography 16 hours to 10 days after the OLT, underwent interventional radiological techniques, including indwelling transcatheter hepatic artery (HA) thrombolysis with a low dose of urokinase, and stent placement into the stenotic segment of HA. Contemporaneous systemic low dose of heparin was given intravenously. Ultrasonography was performed every 12 hours during the intra-arterial (IA) thrombolysis.


RESULTS
HA flow was established in 7 of the 9 patients (78%) 12 hours to 9 days (on average 4.8 days) after the IA thrombolysis with significant improvement of liver functions. HA stenosis (HAS) at the anastomotic stoma was found in 6 of these 7 patients, and stent placement at the stenotic segment was performed successfully in 6 of them with a degree of stenosis over 90%. IA thrombolysis failed in 2 cases. One patient with intraperitoneal hemorrhage 12 hours after the treatment underwent emergent graft revision and the bleeding place was found at the HA anastomotic stoma. One patient remained completely occluded of the HA 7 days after the treatment; however, the collateral flow to the liver was identified. His liver function was improved without further intervention. Follow-up of 6 months (2-14 months) showed that the 7 patients with successful HA recanalization had a good clinical course with normal graft function.


CONCLUSIONS
Transcatheter endovascular interventional techniques are effective on treatment of early HAT after OLT.
Wang
Mao-qiang
MQ
Department of Interventional Radiology, General Hospital of Chinese People's Liberation Army, Beijing 100853, China.
Liu
Feng-yong
FY
Shi
Xian-jie
XJ
Yu
Qiang
Q
Zhang
Wen-zhi
WZ
Zhou
Ning-xin
NX
D000328:Adult; D002404:Catheterization; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006499:Hepatic Artery; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D015642:Radiology, Interventional; D015607:Stents; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator