False positive tardus-parvus waveforms after liver transplantation: a case of wide discrepancy between donor and recipient hepatic arteries mimicking anastomotic stenosis.
BACKGROUND
Parvus-tardus waveforms of the hepatic artery after liver transplantation usually indicate an arterial complication and severe impairment of hepatic arterial perfusion with a sensitivity of 91% and a specificity of 99.1%. Thus, it has been emphasized that detection of such waveforms should prompt emergency angiography.


METHODS
Arterial reconstruction during a liver transplantation was successfully accomplished by an end-to-end anastomosis, performing a "flute-spout" widening of the anastomosis with a 7/0 prolene running suture between a small recipient proper hepatic artery and the donor common hepatic artery.


RESULTS
On day 7 posttransplantation color Doppler ultrasonography revealed a parvus-tardus waveform pattern in the hepatic arterial flow. Computed tomographic (CT) angiography showed only a caliber discrepancy between the donor and recipient stumps, excluding an arterial stenosis or thrombosis. Since normal liver function persisted, the patient underwent routine follow-up. After 15 months the patient was alive and well; hepatic artery spectral waveforms were unchanged and liver functions were consistent with a mild hepatitis C virus (HCV) recurrence.


CONCLUSIONS
This is a report of false positive tardus-parvus waveforms, due to a discrepancy between the donor and recipient arteries despite a wide anastomosis. Knowledge of technical reconstruction details may be helpful for correct interpretation of color Doppler findings. CT angiography should be considered before more invasive examinations.
Urbani
L
L
Hospital of General Surgery and Transplants, Pisa, Italy.
Morelli
L
L
Campatelli
A
A
Montin
U
U
Catalano
G
G
Biancofiore
G
G
Bindi
L
L
Bargellini
I
I
Cioni
R
R
Vignali
C
C
Di Candio
G
G
Mosca
F
F
Filipponi
F
F
D000714:Anastomosis, Surgical; D005189:False Positive Reactions; D007839:Functional Laterality; D006499:Hepatic Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D006526:Hepatitis C / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000145:classification / Q000601:surgery* / Q000821:virology; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D017538:Mesenteric Artery, Superior / Q000002:abnormalities; D008875:Middle Aged; D014019:Tissue Donors; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography