title: Feasibility and Midterm Results of Endovascular Treatment of Hepatic Artery Occlusion within 24 Hours after Living-Donor Liver Transplantation.
abstract: OBJECTIVE
  To evaluate the feasibility and midterm results of endovascular treatment of hepatic artery occlusion within 24 hours after living-donor liver transplantation (LDLT).
  
  
  METHODS
  From January 2012 to June 2014, 189 consecutive patients at a single institution underwent LDLT with right-lobe grafts. Among them, 10 were diagnosed with hepatic artery occlusion within 24 hours after LDLT. All 10 underwent endovascular treatment, including drug-eluting stent placement (n = 2), intraarterial thrombolysis (n = 5), or both (n = 3). Every patient received regular follow-up with multidetector computed tomography (CT). Data on primary technical success, primary and assisted primary patency, and biliary complications were analyzed.
  
  
  RESULTS
  Primary technical success was achieved in all 10 cases. Primary patency rates at 1 week, 3 months, and 6 months were all 70% (7 of 10), and the respective assisted primary patency rates were all 80% (8 of 10). Bleeding at the anastomotic site developed in 2 failed cases, prompting repeat liver transplantation. All 8 successfully recanalized cases showed hepatic artery patency on CT throughout follow-up (mean, 643.6 d; range, 236-1,081 d). Six of these cases had anastomotic biliary stricture, 4 of which were successfully treated by multisession biliary intervention. One patient had nonanastomotic biliary stricture and died of hepatic failure despite lifelong external drainage.
  
  
  CONCLUSIONS
  Endovascular treatment could be an alternative therapeutic option for patients with hepatic artery occlusion within 24 hours after LDLT. It could help achieve long-term patency of the hepatic artery, but biliary stricture can potentially occur, and bleeding at the anastomotic site is a serious complication.
authors: Department of Radiology, National Cancer Center, Goyang, Republic of Korea; Center for Liver Cancer, National Cancer Center, Goyang, Republic of Korea.
authors: In Joon
authors: IJ
authors: Lee
authors: Department of Surgery, National Cancer Center, Goyang, Republic of Korea; Center for Liver Cancer, National Cancer Center, Goyang, Republic of Korea.
authors: Seong Hoon
authors: SH
authors: Kim
authors: Department of Surgery, National Cancer Center, Goyang, Republic of Korea; Center for Liver Cancer, National Cancer Center, Goyang, Republic of Korea.
authors: Seung Duk
authors: SD
authors: Lee
authors: Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
authors: Jae Hwan
authors: JH
authors: Lee
authors: Department of Radiology, National Cancer Center, Goyang, Republic of Korea; Center for Liver Cancer, National Cancer Center, Goyang, Republic of Korea. Electronic address: dockimhb@naver.com.
authors: Hyun Beom
authors: HB
authors: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002779:Cholestasis / Q000209:etiology; D000072226:Computed Tomography Angiography; D054855:Drug-Eluting Stents; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D019106:Postoperative Hemorrhage / Q000209:etiology; D012189:Retrospective Studies; D066106:Seoul; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents