title: Doppler ultrasonography findings of splenic arterial steal syndrome after liver transplant.
abstract: OBJECTIVE
  Splenic arterial steal syndrome is an important cause of morbidity and mortality after orthotopic liver transplant. Splenic arterial steal syndrome is characterized by arterial hypoperfusion of the graft; and if left untreated, causes ischemic biliary tract injury. Selective arterial embolization is important when treating splenic arterial steal syndrome. Doppler ultrasound has been used to follow-up liver transplant patients. This study sought to analyze alterations in portal vein velocity, peak systolic velocity, and resistivity index of the hepatic artery before diagnosis and after treatment of splenic arterial steal syndrome.
  
  
  METHODS
  We analyzed the Duplex Doppler ultrasonography results of 20 liver transplant recipients who developed angiographically proven splenic arterial steal syndrome between January 2005 and March 2009. Peak systolic velocity and resistivity index of the hepatic artery were noted during transplant surgery, before selective arterial embolization, and after embolization procedures.
  
  
  RESULTS
  A statistically significant decrease was found in peak systolic velocity and resistivity index of the hepatic artery between the intraoperative and pre-embolization values. In contrast to the statistically significant increase in peak systolic velocity of the hepatic artery, there were no significant changes in resistivity index after the selective arterial embolization. Portal vein velocity did not show a statistically significant change between intraoperative and preprocedure values. Portal vein velocity did show a tendency to decrease after coil embolization, but this was not significant.
  
  
  CONCLUSIONS
  Doppler ultrasound surveillance is a valuable tool in early detection of hepatic arterial complications. A decrease in peak systolic velocity and resistivity index compared to the corresponding intraoperative data should raise suspicion of splenic arterial steal syndrome. Also Doppler ultrasound can be effectively used to examine the hepatic arterial inflow after selective arterial embolization.
authors: Department of Radiology, Baskent University Faculty of Medicine, Ankara, Turkey. nihalt@hotmail.com
authors: Nihal
authors: N
authors: Uslu
authors: Hulya
authors: H
authors: Aslan
authors: Huseyin Gurkan
authors: HG
authors: Tore
authors: Gokhan
authors: G
authors: Moray
authors: Hamdi
authors: H
authors: Karakayali
authors: Fatih
authors: F
authors: Boyvat
authors: Gulnaz
authors: G
authors: Arslan
authors: Mehmet
authors: M
authors: Haberal
mesh_terms: D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D002648:Child; D004621:Embolization, Therapeutic; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013157:Splenic Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016896:Treatment Outcome; D014421:Turkey; D018615:Ultrasonography, Doppler, Color; D018616:Ultrasonography, Doppler, Duplex; D055815:Young Adult