Percutaneous Transluminal Angioplasty and Stenting for Hepatic Vessel Stenosis after Orthotopic Liver Transplantation.
BACKGROUND
This study aimed to evaluate the efficacy of vascular intervention in percutaneous transluminal angioplasty (PTA) for the treatment of hepatic artery and hepatic vein stenosis after liver transplantation (LT), including thrombotic total occluded lesions.


METHODS
Percutaneous transluminal angioplasty after orthotopic liver transplantation was performed to re-open hepatic vessel lesions. We daily used routine Doppler ultrasound during admission for early detection of graft hepatic vessel lesions, including hepatic artery and vein lesions. In outpatients, Doppler ultrasound was performed every month. Urokinase was delivered with a dose of 150,000-300,000 IU by catheter before PTA for thrombotic total occlusion of the graft for hepatic artery patients. Laboratory data were collected to evaluate the effects of the PTA procedure.


RESULTS
The study involved a total of seven patients, six of whom were successfully treated by a first PTA procedure. Thrombolysis use of urokinase in totally occluded donor hepatic arteries post-LT following stenting was successful in three patients. One complication occurred, an arterial dissection and perforation, finalizing the success rate at ~86% and the complication rate at ~14%. Therefore, our study has a primary patency rate of 100% at 1 and 3 months. Also, the graft survival rate was 100 % and 86 % in the first and third months, respectively.


CONCLUSIONS
PTA with stenting is an effective treatment for hepatic vessel stenosis, including hepatic arteries and hepatic veins, after a liver transplantation without an increase in the complication rate. In addition, thrombolysis using urokinase intra-artery infusion in graft thrombotic total occluded patients is a good treatment strategy as well.


BACKGROUND
Angioplasty; Complication; Liver transplantation.
Division of Cardiovascular Center, Department of Medicine;
Ming-Yuan
MY
Luo
Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan.
Yi-Ju
YJ
Wu
Division of Cardiovascular Center, Department of Medicine;
Tung-Chao
TC
Lin
Division of Cardiovascular Center, Department of Medicine;
Thau-Yun
TY
Shen
Division of Cardiovascular Center, Department of Medicine;
Ho-Pang
HP
Yang
Division of Cardiovascular Center, Department of Medicine;
Chien-Cheng
CC
Chen
Division of Cardiovascular Center, Department of Medicine;
Fu-Chung
FC
Chen