title: Long-term outcomes of percutaneous venoplasty and Gianturco stent placement to treat obstruction of the inferior vena cava complicating liver transplantation.
abstract: OBJECTIVE
  Evaluation of long-term outcomes of venoplasty and Gianturco stents to treat inferior vena cava (IVC) obstruction after liver transplantation.
  
  
  METHODS
  We retrospectively analyzed records from 33 consecutive adult patients referred with the intent to treat suspected IVC obstruction after liver transplantation. Treatment was performed for occlusion or stenosis with a gradient exceeding 3 mmHg. The primary treatment was venoplasty and, if refractory, Gianturco stent placement. Recurrence prompted repeat venoplasty or stent placement.
  
  
  RESULTS
  Of the 33 patients, 25 (aged 46.9 ± 12.2 years) required treatment at a mean of 2.3 years (14 days to 20.3 years) after transplantation. For technically successful cases, primary treatment was venoplasty alone (14) or with stent placement (10). Technical success was 96 % (24 of 25) reflecting failure to cross one occlusion. Clinical success was 88 % (22 of 25) reflecting the technical failure and two that died of unrelated complications within 5 weeks. Cumulative primary patencies were 57.1 % at 6 months (n = 21) and 51.4 % at 1 (n = 10), 3 (n = 7), 5 (n = 6), and 7 (n = 5) years. Cumulative primary assisted patency was 95.2 % at 6 months (n = 21) and at 1 (n = 15), 3 (n = 9), 5 (n = 8), and 7 (n = 8) years. The 17 patients stented for refractory (n = 10) or recurrent (n = 7) stenosis had cumulative primary and primary assisted patencies of 86.0 and 100 %, respectively, from 6 months (n = 14) to 7 years (n = 3). No major complications occurred; one fractured stent was observed after 11.6 years.
  
  
  CONCLUSIONS
  For IVC obstruction following liver transplantation, excellent long-term outcomes can be achieved by venoplasty and Gianturco stent placement.
authors.affiliation: University of Chicago, 5841 S Maryland Ave., MC2026, Chicago, IL, 60637, USA, jlorenz@radiology.bsd.uchicago.edu.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Lorenz
authors.forename: Darren
authors.initials: D
authors.lastname: van Beek
authors.forename: Brian
authors.initials: B
authors.lastname: Funaki
authors.forename: Thuong G
authors.initials: TG
authors.lastname: Van Ha
authors.forename: Stephen
authors.initials: S
authors.lastname: Zangan
authors.forename: Rakesh
authors.initials: R
authors.lastname: Navuluri
authors.forename: Jeffery A
authors.initials: JA
authors.lastname: Leef
mesh_terms: D000328:Adult; D000368:Aged; D017130:Angioplasty / Q000379:methods*; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014682:Vena Cava, Inferior