title: Endovascular treatment with primary stenting of inferior cava vein torsion following orthotopic liver transplantation with modified piggyback technique.
abstract: OBJECTIVE
  This study was undertaken to evaluate primary stenting in patients with inferior vena cava torsion after orthotopic liver transplantation performed with modified piggyback technique.
  
  
  METHODS
  From November 2003 to October 2010, six patients developed clinical, laboratory and imaging findings suggestive of caval stenosis, after a mean period of 21 days from an orthotopic liver transplantation performed with modified piggyback technique. Vena cavography showed stenosis due to torsion of the inferior vena cava at the anastomoses and a significant caval venous pressure gradient. All patients were treated with primary stenting followed by in-stent angioplasty in three cases.
  
  
  RESULTS
  In all patients, the stents were successfully positioned at the caval anastomosis and the venous gradient pressure fell from a mean value of 10 to 2 mmHg. Signs and symptoms resolved in all six patients. One patient died 3 months after stent placement due to biliary complications. No evidence of recurrence or complications was noted during the follow-up (mean 49 months).
  
  
  CONCLUSIONS
  Primary stenting of inferior vena cava stenosis due to torsion of the anastomoses in patients receiving orthotopic liver transplantation with modified piggyback technique is a safe, effective and durable treatment.
authors.affiliation: Dipartimento di Radiologia e Radiologia Interventistica, IRCCS Azienda Ospedaliera ed Universitaria San Martino, IST-Istituto Nazionale per la Ricerca sul Cancro, Monoblocco 1-Fondi, Largo Rosanna Benzi 10, 16132, Genoa, Italy, carloferro@yahoo.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Ferro
authors.forename: Enzo
authors.initials: E
authors.lastname: Andorno
authors.forename: Andrea
authors.initials: A
authors.lastname: Guastavino
authors.forename: Umberto G
authors.initials: UG
authors.lastname: Rossi
authors.forename: Sara
authors.initials: S
authors.lastname: Seitun
authors.forename: Giulio
authors.initials: G
authors.lastname: Bovio
authors.forename: Umberto
authors.initials: U
authors.lastname: Valente
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery*