Endovascular stent placement for interposed middle hepatic vein graft occlusion after living-donor liver transplantation using right-lobe graft.
Middle hepatic vein (MHV) reconstruction is performed to drain the right paramedian sector to prevent hepatic venous congestion (HVC). The aim of the present study was to evaluate endovascular stent placement in patients with stenosed and/or occluded interposition vein graft (IVG) to segment V hepatic vein (V5) and segment VIII hepatic vein (V8) after living-donor liver transplantation (LDLT). The procedure was performed in 11 recipients; 7 underwent it within 24 hours of LDLT. The following parameters, including technical success, clinical success, complications, patient survival data, and serial computed tomography (CT) findings during follow-up, were documented retrospectively. Technical success was defined as both successful stent placement and resolution of stenosis or occlusion with copious flow of contrast medium through the stent, while clinical success was defined as both improvement of liver function tests (LFTs) and reduction or disappearance of hepatic low-attenuation areas on follow-up CT scans taken within 1 week of stent placement. Technical success was achieved in 10 of 11 patients (91%), and clinical success was achieved in 9 of 11 patients (82%). Acute thrombotic occlusion of the stent-inserted hepatic vein occurred in 1 patient 1 day following stent placement. During the mean follow-up period of 468 days (range, 13-891 days), 9 patients survived and 2 patients died. No death was directly related to stent placement or its related complications. The low-attenuation area in the involved hepatic segment V (S5) and/or VIII (S8) area prior to stent placement disappeared completely on follow-up CT scans performed at 3-12 days (mean, 5.4 days) after stent placement in all 9 patients with clinical success. No attenuation change occurred even in cases with chronic occlusion of the stent-inserted hepatic veins. In conclusion, though IVG to V5 and V8 remains controversial, the treatment of their stenosis or occlusion is safe and effective, even during their immediate postoperative period.
Shin
Ji Hoon
JH
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea.
Sung
Kyu-Bo
KB
Yoon
Hyun-Ki
HK
Ko
Gi-Young
GY
Kim
Kyoung Won
KW
Lee
Sung-Gyu
SG
Hwang
Shin
S
Ahn
Chul-Soo
CS
Kim
Ki-Hun
KH
Moon
Deok-Bog
DB
Song
Ho-Young
HY
Ha
Tae-Yong
TY
D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000601:surgery*; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D017093:Liver Failure / Q000175:diagnosis / Q000601:surgery; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011183:Postoperative Complications / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014654:Vascular Patency / Q000502:physiology; D014656:Vascular Surgical Procedures / Q000379:methods