title: Collateral Development in Thrombosis of the Hepatic Artery After Transplantation.
abstract: OBJECTIVE
  The authors sought to identify strictures or hepatic artery obstruction with posterior collateral transformation in our series of liver transplantation, treatment, and evolution. The thrombosis or severe hepatic artery stenosis sometimes presents a compensation mechanism, the collateral transformation of the artery.
  
  
  METHODS
  From April 2002 to December 2011 we collected 18 cases of collateral transformation. We analyzed data regarding the transplantation, diagnosis, treatment, clinical evolution, liver function, and Doppler-ultrasound.
  
  
  RESULTS
  The main indication was alcoholic cirrhosis, followed by hepatocellular carcinoma - hepatitis C virus. The mean cold ischemia time was 292.2 minutes mean hot ischemia was 48.8. The anastomosis was performed on the gastroduodenal-splenic patch donor in 14 cases, the celiac trunk in 2 cases, and on grafts to the aorta in another 2. Doppler ultrasound showed 8 cases without complications, 8 with low flows, and 2 cases with alterations of the right hepatic artery. Computed tomographic (CT) angiography was performed in patients with impaired eco-Doppler and found 4 obstructions, 2 cases with kinking, 1 stenosis, and 3 normal cases. Three patients with low flows were re-operated and another re-transplanted. After diagnosis of collateral transformation, all were treated with antiplatelet agents. Two cases of angioplasty were associated. The collaterals were diagnosed 1 month to 44.8 months after transplantation. Five patients died. In the latest data, 10 patients do not have analytical alteration. The Doppler ultrasound shows 7 cases being normal and 6 with flow but low resistances.
  
  
  CONCLUSIONS
  In our series, all patients with collateral transformation, except one who was transplanted, maintain good liver function with permeable vessels.
authors.affiliation: Department of General Surgery (HPB and Liver Transplant Unit), University Hospital Central of Asturias (HUCA), University of Oviedo, Oviedo, Spain. Electronic address: cmgbernardo2@hotmail.com.
authors.forename: C M
authors.initials: CM
authors.lastname: García Bernardo
authors.affiliation: Department of Radiology, University Hospital Central of Asturias (HUCA), University of Oviedo, Oviedo, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Argüelles García
authors.affiliation: Department of Radiology, University Hospital Central of Asturias (HUCA), University of Oviedo, Oviedo, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Redondo Buil
authors.affiliation: Department of General Surgery (HPB and Liver Transplant Unit), University Hospital Central of Asturias (HUCA), University of Oviedo, Oviedo, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Miyar de León
authors.affiliation: Department of Digestive Diseases (Liver Transplant Unit), University Hospital Central of Asturias (HUCA), University of Oviedo, Oviedo, Spain.
authors.forename: L
authors.initials: L
authors.lastname: González Dieguez
authors.affiliation: Department of Digestive Diseases (Liver Transplant Unit), University Hospital Central of Asturias (HUCA), University of Oviedo, Oviedo, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Cadahía Rodrigo
authors.affiliation: Department of General Surgery (HPB and Liver Transplant Unit), University Hospital Central of Asturias (HUCA), University of Oviedo, Oviedo, Spain.
authors.forename: I
authors.initials: I
authors.lastname: González-Pinto Arrillaga
authors.affiliation: Department of General Surgery (HPB and Liver Transplant Unit), University Hospital Central of Asturias (HUCA), University of Oviedo, Oviedo, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Vázquez Velasco
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000503:physiopathology / Q000601:surgery; D002445:Celiac Artery / Q000601:surgery; D003097:Collateral Circulation / Q000502:physiology*; D000072226:Computed Tomography Angiography; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D015150:Echocardiography, Doppler; D006499:Hepatic Artery; D019698:Hepatitis C, Chronic / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000503:physiopathology / Q000601:surgery; D008113:Liver Neoplasms / Q000503:physiopathology / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D014019:Tissue Donors