Quantifying increased hepatic arterial flow with test balloon occlusion of the splenic artery in liver transplant recipients with suspected splenic steal syndrome: quantitative digitally subtracted angiography correlation with arterial Doppler parameters.
OBJECTIVE
The purpose of this study is to quantify hepatic arterial flow (HAF) in liver transplants with splenic steal syndrome (SSS) pre- and post-test balloon occlusion of the splenic artery utilizing Doppler ultrasound (DUS) and quantitative digitally subtracted angiography (Q-DSA).


METHODS
A total of 193 liver transplants were evaluated retrospectively. Hepatic arterial velocity (HAV) and HAF were calculated utilizing DUS and Q-DSA (i-flow prototype, Siemens) pre- and post-splenic artery balloon occlusion. The rate of HAF increase, total HAF, and peak contrast density (PKD) by Q-DSA were compared with HAF by DUS.


RESULTS
Of all, 4 suspected SSS cases underwent test-balloon occlusion with DUS and Q-DSA. Using DUS, HAV and HAF increased by 1.6- to 1.8-fold and 1.7- to 2.6-fold, respectively. Using Q-DSA, the HAF rate, total HAF, and PKD increased by 1.1 to 12.8, 1.5 to 7.6, and 1.3 to 5.3, respectively.


CONCLUSIONS
Occlusion of the splenic artery in liver transplants with SSS doubles the HAF (+1.7- to 2.6-fold). The Q-DSA parameters correlate qualitatively but overestimate the resultant increased HAF.
Division of Vascular Interventional Radiology, Department of Radiology & Imaging Sciences, University of Virginia Health System, Charlottesville, VA 22908, USA. wspikes@yahoo.com
Wael E
WE
Saad
Curtis L
CL
Anderson
Markus
M
Kowarschik
Ulku C
UC
Turba
Timothy M
TM
Schmitt
Sean C
SC
Kumer
Alan H
AH
Matsumoto
John F
JF
Angle
D015901:Angiography, Digital Subtraction; D021721:Balloon Occlusion; D001783:Blood Flow Velocity; D004621:Embolization, Therapeutic; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D012189:Retrospective Studies; D013157:Splenic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014768:Virginia