title: Primary stent placement for hepatic artery stenosis after liver transplantation.
abstract: OBJECTIVE
  Significant hepatic artery stenosis (HAS) after orthotopic liver transplantation (OLT) can lead to thrombosis, with subsequent liver failure in 30% of patients. Although operative intervention or retransplantation has been the traditional solution, endovascular therapy has emerged as a less invasive treatment strategy. Prior smaller studies have been conflicting in the relative efficacy of percutaneous transluminal angioplasty (PTA) vs primary stent placement for HAS.
  
  
  METHODS
  This was a single-center retrospective review of all endovascular interventions for HAS after OLT during a 54-month period (August 2009-December 2013). Patients with ultrasound imaging with evidence of severe HAS (peak systolic velocity >400-450 cm/s, resistive index <0.5) underwent endovascular treatment with primary stent placement or PTA. Outcomes calculated were technical success, primary and primary assisted patency rates, reinterventions, and complications.
  
  
  RESULTS
  Sixty-two interventions for HAS were performed in 42 patients with a mean follow-up of 19.1 ± 15.2 months. During the study period, 654 OLTs were performed. Of 61 patients diagnosed with HAS, 42 underwent an endovascular intervention. The rate of endovascularly treated HAS was 6.4% (42 of 654). Primary technical success was achieved in 95% (59 of 62) of the interventions. Initial treatment was with PTA alone in 17 or primary stent in 25. Primary patency rates after initial stent placement were 87%, 76.5%, 78%, and 78% at 1, 6, 12, and 24 months, respectively, compared with initial PTA rates of 64.7%, 53.3%, 40%, and 0% (P = .19). There were 20 reinterventions in 14 patients (eight stents, six PTAs). The time to the initial reintervention was 51 days in patients with PTA alone vs 105.8 days for those with an initial stent (P = .16). Overall primary assisted patency was 93% at 24 months. Major complications were one arterial rupture and two hepatic artery dissections. The long-term risk of hepatic artery thrombosis in the entire patient cohort was 3.2%.
  
  
  CONCLUSIONS
  HAS after OLT can be treated endovascularly with high technical success and excellent primary assisted patency. This series represents the largest reported cohort of endovascular interventions for HAS to date. Initial use of a stent showed a strong trend toward decreasing the need for reintervention. Avoidance of hepatic artery thrombosis is possible in >95% of patients with endovascular treatment and close follow-up.
authors.affiliation: Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La.
authors.forename: Linda
authors.initials: L
authors.lastname: Le
authors.affiliation: Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La.
authors.forename: William
authors.initials: W
authors.lastname: Terral
authors.affiliation: Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Zea
authors.affiliation: Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La.
authors.forename: Hernan A
authors.initials: HA
authors.lastname: Bazan
authors.affiliation: Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La.
authors.forename: Taylor A
authors.initials: TA
authors.lastname: Smith
authors.affiliation: Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La.
authors.forename: George E
authors.initials: GE
authors.lastname: Loss
authors.affiliation: Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La.
authors.forename: Edward
authors.initials: E
authors.lastname: Bluth
authors.affiliation: Department of Surgery, Section of Vascular and Endovascular Surgery, Ochsner Clinic, New Orleans, La. Electronic address: csternbergh@ochsner.org.
authors.forename: W Charles
authors.initials: WC
authors.lastname: Sternbergh
mesh_terms: D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001783:Blood Flow Velocity; D003251:Constriction, Pathologic; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects*; D055820:New Orleans; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014654:Vascular Patency