Endovascular management of early hepatic artery thrombosis after living donor liver transplantation.
To study the feasibility of endovascular management of early hepatic artery thrombosis (HAT) after living-donor liver transplantation (LDLT) and to clarify its role as a less invasive alternative to open surgery. A retrospective review of 360 recipients who underwent LDLT. Early HAT developed in 13 cases (3.6%). Diagnosis was performed using Doppler, CT angiography, and digital subtraction angiography. Intra-arterial thrombolysis (IAT) was performed using streptokinase or tPA. In case of underlying stricture, PTA was attempted. If the artery did not recanalize, continuous infusion was performed and monitored using Doppler US. Initial surgical revascularization was successful in 2/13 cases. IAT was performed in 11/13 cases. The initial success rate was 81.8% (9/11), the failure rate was 18.2% (2/11). Rebound thrombosis developed in 33.3% (3/9). Hemorrhage developed after IAT in 2/11 cases (18.2%). Definite endovascular treatment of HAT was achieved in 6/11 cases (54.5%) and definite treatment (surgical, endovascular or combined) in 9/13 cases (69%). (Follow-up 4 months-4 years). Endovascular management of early HAT after LDLT is a feasible and reliable alternative to open surgery. It plays a role as a less invasive approach with definite endovascular treatment rate of 54.5%.
Diagnostic and Intervention Radiology Department, Cairo University Hospitals, Cairo, Egypt. ohamada@yahoo.com
Omar
O
Abdelaziz
Karim
K
Hosny
Ayman
A
Amin
Sally
S
Emadeldin
Shinji
S
Uemoto
Mohamed
M
Mostafa
D000328:Adult; D017130:Angioplasty; D057510:Endovascular Procedures / Q000379:methods*; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000628:therapy*; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler