Arcuate ligament syndrome inducing hepatic artery thrombosis after liver transplantation.
BACKGROUND
Hepatic artery thrombosis (HAT) is a frequent complication following liver transplantation, but it is rarely caused by arcuate ligament compression of the celiac artery. This article mainly describes our experience in managing a patient with celiac artery stenosis and HAT after liver transplantation.


METHODS
A 44-year-old man with a 15-year history of hepatitis B was admitted to our hospital for hepatocellular carcinoma. Before the operation, he received transarterial chemoembolization once, and pretransplant MR angiography indicated a suspected stenosis at the initiation of the celiac artery, while color Doppler showed normal blood flow in the arterial system. In this case, orthotopic liver transplantation was performed for radical cure of hepatocellular carcinoma. However, B-ultrasonography detected poor blood flow in the intra- and extra-hepatic artery on the first posttransplant day, and during exploratory laparotomy a thrombus was found in the hepatic artery. Thus, re-transplantation was conducted with a bypass between the graft hepatic artery and the recipient abdominal aorta with the donor's splenic artery.


RESULTS
The patient made an uneventful recovery and color Doppler showed good blood flow in the artery and portal system. Histology confirmed extensive thrombosis in the left and right hepatic artery of the explanted graft, indicating HAT.


CONCLUSIONS
Although HAT caused by celiac trunk compression is rarely reported in liver transplantation, the diagnosis should be considered in patients with pretransplant hepatic artery stenosis on angiography and abnormal blood flow on B-ultrasonography. Once HAT is formed, treatment such as thrombectomy or re-transplantation should be performed as early as possible.
Jiang
Zhi-Jun
ZJ
Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Liang
Ting-Bo
TB
Feng
Xiao-Ning
XN
Wang
Wei-Lin
WL
Shen
Yan
Y
Zhang
Min
M
Wu
Jian
J
Xu
Xiao
X
Zheng
Shu-Sen
SS
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D002445:Celiac Artery / Q000473:pathology*; D003251:Constriction, Pathologic; D006499:Hepatic Artery / Q000473:pathology; D006801:Humans; D008022:Ligaments / Q000473:pathology* / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D018810:Magnetic Resonance Angiography; D008297:Male; D012086:Reoperation; D013577:Syndrome; D013927:Thrombosis / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome