title: Catheter thrombolysis of thrombosed hepatic arteries in liver transplant recipients: predictors of success and role of thrombolysis.
abstract: Hepatic artery thrombosis is an uncommon complication of liver transplantation. However, it is a major indication for re-transplantation. The use of transcatheter thrombolysis and subsequent surgical revascularization as a graft salvage procedure is discussed. Four of 5 cases (80%) were successful in re-establishing flow and uncovering underlying arterial anatomic defects. None were treated definitively by endoluminal measures due to an inability to resolve the underlying anatomic defects. However, 2 of 5 cases (40%) went on to a successful surgical revascularization and represent successful long-term outcome of transcatheter thrombolysis followed by definitive surgical revascularization. We conclude that, definitive endoluminal success cannot be achieved without resolving associated, and possibly instigating, underlying arterial anatomical defects. However, reestablishing flow to the graft can unmask underlying lesions as well as asses surrounding vasculature thus providing anatomical information for a more elective, better planned and definitive surgical revision.
authors.affiliation: Department of Imaging Sciences, Section of Vascular/Interventional Radiology, University of Rochester Medical Center, 601 Elmwood Avenue, New York, NY 14642, USA. wspikes@yahoo.com
authors.forename: Wael E A
authors.initials: WE
authors.lastname: Saad
authors.forename: Mark G
authors.initials: MG
authors.lastname: Davies
authors.forename: Nael E A
authors.initials: NE
authors.lastname: Saad
authors.forename: Karin E
authors.initials: KE
authors.lastname: Westesson
authors.forename: Nikhil C
authors.initials: NC
authors.lastname: Patel
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Sahler
authors.forename: David E
authors.initials: DE
authors.lastname: Lee
authors.forename: Takashi
authors.initials: T
authors.lastname: Kitanosono
authors.forename: Talia
authors.initials: T
authors.lastname: Sasson
authors.forename: David L
authors.initials: DL
authors.lastname: Waldman
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006084:Graft Rejection / Q000517:prevention & control; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012086:Reoperation; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D014654:Vascular Patency
chemical_list: D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator