title: Percutaneous transluminal venoplasty after venous pressure measurement in patients with hepatic venous outflow obstruction after living donor liver transplantation.
abstract: OBJECTIVE
  The aim of this study was to evaluate retrospectively the outcome of percutaneous transluminal venoplasty (PTV) after venous pressure measurement in patients with hepatic venous outflow obstruction following living donor liver transplantation (LDLT).
  
  
  METHODS
  We studied 24 consecutive patients suspected of having hepatic venous outflow obstruction after LDLT. Pressure gradients were measured proximal and distal to the lesion, and gradient values >3 mmHg were considered hemodynamically significant. We evaluated the technical success, complications, outcome of venoplasty and recurrence, and the patency rate.
  
  
  RESULTS
  In all, 11 female patients manifested a pressure gradient >3 mmHg across the anastomotic site; they underwent subsequent PVT. The initial balloon venoplasty procedure was technically successful in 10 of the 11 patients (91%), and the pressure gradient was reduced from 5.8 to 1.1 mmHg (P < 0.01). Clinical improvement was observed in 9 of these 10 patients; one patient failed to improve and underwent retransplantation. Recurrent obstruction occurred in four patients; they underwent PTV with (n = 2) or without (n = 2) stent placement. There were no major procedural complications.
  
  
  CONCLUSIONS
  PTV following venous pressure measurement is an effective and safe treatment for venous outflow obstruction in patients subjected to LDLT. In patients with recurrent obstruction, re-venoplasty is recommended.
authors.affiliation: Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Kumamoto, Japan. osamu-3643ik@do9.enjoy.ne.jp
authors.forename: Osamu
authors.initials: O
authors.lastname: Ikeda
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Tamura
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nakasone
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Hideaki
authors.initials: H
authors.lastname: Okajima
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Asonuma
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Inomata
mesh_terms: D000293:Adolescent; D000328:Adult; D000792:Angiography; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D002404:Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014654:Vascular Patency; D014690:Venous Pressure
references.citation: J Vasc Interv Radiol. 1994 Jan-Feb;5(1):121-6
references.pmid: 8136588
references.citation: Pediatr Surg Int. 2004 Feb;20(2):87-90
references.pmid: 14770324
references.citation: AJR Am J Roentgenol. 1991 Jul;157(1):167-71
references.pmid: 1828649
references.citation: Ann Surg. 2002 Nov;236(5):658-66
references.pmid: 12409673
references.citation: Clin Transplant. 1998 Aug;12(4):292-9
references.pmid: 9686322
references.citation: Pediatr Transplant. 2000 Nov;4(4):322-7
references.pmid: 11079274
references.citation: Clin Transplant. 2000 Jun;14(3):235-41
references.pmid: 10831082
references.citation: Radiology. 2005 Jul;236(1):352-9
references.pmid: 15955856
references.citation: J Vasc Interv Radiol. 1999 Jan;10(1):17-22
references.pmid: 10872484
references.citation: Ann Surg. 1993 Jan;217(1):82-91
references.pmid: 8424706
references.citation: Surgery. 1997 Mar;121(3):250-7
references.pmid: 9068666
references.citation: N Engl J Med. 1989 Oct 12;321(15):1014-22
references.pmid: 2674716
references.citation: Transplant Proc. 1998 Nov;30(7):3205
references.pmid: 9838416
references.citation: Transpl Int. 1995;8(2):119-25
references.pmid: 7766293
references.citation: Radiology. 2006 Apr;239(1):285-90
references.pmid: 16567488
references.citation: Surgery. 1996 Sep;120(3):484-7
references.pmid: 8784401
references.citation: J Vasc Interv Radiol. 2008 Oct;19(10):1439-48
references.pmid: 18760627
references.citation: Radiology. 2000 Apr;215(1):147-51
references.pmid: 10751480
references.citation: Radiology. 1998 Apr;207(1):153-60
references.pmid: 9530311
references.citation: Surg Gynecol Obstet. 1993 Jan;176(1):11-7
references.pmid: 8427000
references.citation: J Vasc Interv Radiol. 2000 Feb;11(2 Pt 1):177-87
references.pmid: 10716387
references.citation: J Vasc Interv Radiol. 2002 Jun;13(6):591-9
references.pmid: 12050299
references.citation: Ann Surg. 1990 Sep;212(3):368-75; discussion 375-7
references.pmid: 2396888
references.citation: Pediatr Transplant. 2005 Jun;9(3):293-8
references.pmid: 15910383
references.citation: J Vasc Interv Radiol. 2001 Jan;12(1):55-9
references.pmid: 11200354
references.citation: Clin Transplant. 1993;7(4):306-11
references.pmid: 10146300