Digestive Disease Interventions 2020; 04(02): 180-186
DOI: 10.1055/s-0040-1710593
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hepatic Artery Interventions in the Transplant Patient

Zachary Berman
1   Division of Interventional Radiology, Department of Radiology, University of California, San Diego, San Diego, California
,
Hamed Aryafar
1   Division of Interventional Radiology, Department of Radiology, University of California, San Diego, San Diego, California
› Author Affiliations
Further Information

Publication History

16 October 2019

20 March 2020

Publication Date:
13 May 2020 (online)

Abstract

Arterial complications are some of the feared complications of hepatic transplantation. This stems from the fact that while hepatocytes derive most of their blood supply from the portal vasculature, bile ducts get their supply from the hepatic artery. Arterial insufficiency overtime causes biliary ischemia, necrosis, and often hepatic graft failure. Once suspected clinically, a prompt imaging work-up is usually performed. After confirmation of suspected hepatic arterial injury or insufficiency, quick intervention is usually required. Knowledge of the common hepatic artery complications, their imaging diagnosis, and different treatment modalities is critical for any provider who treats these patients. This review covers the imaging diagnosis and types of vascular injuries, and analyzes the different treatment options.

 
  • References

  • 1 Starzl TE, Brettschneider L, Penn I. , et al. Orthotopic liver transplantation in man. Transplant Proc 1969; 1 (01) 216-222
  • 2 Starzl TE, Porter KA, Brettschneider L. , et al. Clinical and pathologic observations after orthotopic transplantation of the human liver. Surg Gynecol Obstet 1969; 128 (02) 327-339
  • 3 Lladó L, Figueras J. Techniques of orthotopic liver transplantation. HPB (Oxford) 2004; 6 (02) 69-75
  • 4 Duffy JP, Hong JC, Farmer DG. , et al. Vascular complications of orthotopic liver transplantation: experience in more than 4,200 patients. J Am Coll Surg 2009; 208 (05) 896-903 , discussion 903–905
  • 5 Mourad MM, Liossis C, Gunson BK. , et al. Etiology and management of hepatic artery thrombosis after adult liver transplantation. Liver Transpl 2014; 20 (06) 713-723
  • 6 Bekker J, Ploem S, de Jong KP. Early hepatic artery thrombosis after liver transplantation: a systematic review of the incidence, outcome and risk factors. Am J Transplant 2009; 9 (04) 746-757
  • 7 Uchiyama H, Hashimoto K, Hiroshige S. , et al. Hepatic artery reconstruction in living-donor liver transplantation: a review of its techniques and complications. Surgery 2002; 131 (1, Suppl): S200-S204
  • 8 Del Gaudio M, Grazi GL, Ercolani G. , et al. Outcome of hepatic artery reconstruction in liver transplantation with an iliac arterial interposition graft. Clin Transplant 2005; 19 (03) 399-405
  • 9 Özbilgin M, Ünek T, Egeli T. , et al. Hepatic artery reconstruction with autologous inferior mesenteric artery graft in living donor liver transplant recipients. Transplant Proc 2017; 49 (03) 566-570
  • 10 Crossin JD, Muradali D, Wilson SR. US of liver transplants: normal and abnormal. Radiographics 2003; 23 (05) 1093-1114
  • 11 Nolten A, Sproat IA. Hepatic artery thrombosis after liver transplantation: temporal accuracy of diagnosis with duplex US and the syndrome of impending thrombosis. Radiology 1996; 198 (02) 553-559
  • 12 García-Criado A, Gilabert R, Salmerón JM. , et al. Significance of and contributing factors for a high resistive index on Doppler sonography of the hepatic artery immediately after surgery: prognostic implications for liver transplant recipients. AJR Am J Roentgenol 2003; 181 (03) 831-838
  • 13 Flint EW, Sumkin JH, Zajko AB, Bowen A. Duplex sonography of hepatic artery thrombosis after liver transplantation. AJR Am J Roentgenol 1988; 151 (03) 481-483
  • 14 Di Martino M, Rossi M, Mennini G. , et al. Imaging follow-up after liver transplantation. Br J Radiol 2016; 89 (1064): 20151025
  • 15 Fulcher AS, Turner MA. Orthotopic liver transplantation: evaluation with MR cholangiography. Radiology 1999; 211 (03) 715-722
  • 16 Boraschi P, Donati F. Biliary-enteric anastomoses: spectrum of findings on Gd-EOB-DTPA-enhanced MR cholangiography. Abdom Imaging 2013; 38 (06) 1351-1359
  • 17 Ma L, Lu Q, Luo Y. Vascular complications after adult living donor liver transplantation: Evaluation with ultrasonography. World J Gastroenterol 2016; 22 (04) 1617-1626
  • 18 García-Criado A, Gilabert R, Nicolau C. , et al. Early detection of hepatic artery thrombosis after liver transplantation by Doppler ultrasonography: prognostic implications. J Ultrasound Med 2001; 20 (01) 51-58
  • 19 Abdelaziz O, Hosny K, Amin A, Emadeldin S, Uemoto S, Mostafa M. Endovascular management of early hepatic artery thrombosis after living donor liver transplantation. Transpl Int 2012; 25 (08) 847-856
  • 20 Silva MA, Jambulingam PS, Gunson BK. , et al. Hepatic artery thrombosis following orthotopic liver transplantation: a 10-year experience from a single centre in the United Kingdom. Liver Transpl 2006; 12 (01) 146-151
  • 21 Lee IJ, Kim SH, Lee SD, Lee JH, Kim HB. Feasibility and midterm results of endovascular treatment of hepatic artery occlusion within 24 hours after living-donor liver transplantation. J Vasc Interv Radiol 2017; 28 (02) 269-275
  • 22 Kogut MJ, Shin DS, Padia SA, Johnson GE, Hippe DS, Valji K. Intra-arterial thrombolysis for hepatic artery thrombosis following liver transplantation. J Vasc Interv Radiol 2015; 26 (09) 1317-1322
  • 23 Singhal A, Stokes K, Sebastian A, Wright HI, Kohli V. Endovascular treatment of hepatic artery thrombosis following liver transplantation. Transpl Int 2010; 23 (03) 245-256
  • 24 Bhattacharjya S, Gunson BK, Mirza DF. , et al. Delayed hepatic artery thrombosis in adult orthotopic liver transplantation-a 12-year experience. Transplantation 2001; 71 (11) 1592-1596
  • 25 Piardi T, Lhuaire M, Bruno O. , et al. Vascular complications following liver transplantation: A literature review of advances in 2015. World J Hepatol 2016; 8 (01) 36-57
  • 26 Hidalgo EG, Abad J, Cantarero JM. , et al. High-dose intra-arterial urokinase for the treatment of hepatic artery thrombosis in liver transplantation. Hepatogastroenterology 1989; 36 (06) 529-532
  • 27 Boyvat F, Aytekin C, Harman A, Sevmiş S, Karakayali H, Haberal M. Endovascular stent placement in patients with hepatic artery stenoses or thromboses after liver transplant. Transplant Proc 2008; 40 (01) 22-26
  • 28 Cotroneo AR, Di Stasi C, Cina A. , et al. Stent placement in four patients with hepatic artery stenosis or thrombosis after liver transplantation. J Vasc Interv Radiol 2002; 13 (06) 619-623
  • 29 Reyes-Corona J, Gonzalez-Huezo MS, Zea-Medina MV, Zamora-Valdés D, Victoria-Campos JL, Mondragon-Sanchez RJ. Paclitaxel coated-stent for early-onset thrombosis after liver transplantation. Ann Hepatol 2007; 6 (04) 272-275
  • 30 Pulitano C, Joseph D, Sandroussi C. , et al. Hepatic artery stenosis after liver transplantation: is endovascular treatment always necessary?. Liver Transpl 2015; 21 (02) 162-168
  • 31 Rostambeigi N, Hunter D, Duval S, Chinnakotla S, Golzarian J. Stent placement versus angioplasty for hepatic artery stenosis after liver transplant: a meta-analysis of case series. Eur Radiol 2013; 23 (05) 1323-1334
  • 32 Park YS, Kim KW, Lee SJ. , et al. Hepatic arterial stenosis assessed with doppler US after liver transplantation: frequent false-positive diagnoses with tardus parvus waveform and value of adding optimal peak systolic velocity cutoff. Radiology 2011; 260 (03) 884-891
  • 33 Saad WE, Davies MG, Sahler L. , et al. Hepatic artery stenosis in liver transplant recipients: primary treatment with percutaneous transluminal angioplasty. J Vasc Interv Radiol 2005; 16 (06) 795-805
  • 34 Le L, Terral W, Zea N. , et al. Primary stent placement for hepatic artery stenosis after liver transplantation. J Vasc Surg 2015; 62 (03) 704-709
  • 35 Patel JV, Weston MJ, Kessel DO, Prasad R, Toogood GJ, Robertson I. Hepatic artery pseudoaneurysm after liver transplantation: treatment with percutaneous thrombin injection. Transplantation 2003; 75 (10) 1755-1757
  • 36 Volpin E, Pessaux P, Sauvanet A. , et al. Preservation of the arterial vascularisation after hepatic artery pseudoaneurysm following orthotopic liver transplantation: long-term results. Ann Transplant 2014; 19: 346-352
  • 37 Marshall MM, Muiesan P, Srinivasan P. , et al. Hepatic artery pseudoaneurysms following liver transplantation: incidence, presenting features and management. Clin Radiol 2001; 56 (07) 579-587
  • 38 Parlak S, Gulcek S, Kaplanoglu H, Altin L, Deveer M, Pasaoglu L. Hepatic artery pseudoaneurysm: a life-threatening complication of liver transplantation. J Belg Soc Radiol 2015; 99 (02) 61-64
  • 39 Fistouris J, Herlenius G, Bäckman L. , et al. Pseudoaneurysm of the hepatic artery following liver transplantation. Transplant Proc 2006; 38 (08) 2679-2682
  • 40 Kim HJ, Kim KW, Kim AY. , et al. Hepatic artery pseudoaneurysms in adult living-donor liver transplantation: efficacy of CT and Doppler sonography. AJR Am J Roentgenol 2005; 184 (05) 1549-1555
  • 41 Thorat A, Lee CF, Wu TH. , et al. Endovascular treatment for pseudoaneurysms arising from the hepatic artery after liver transplantation. Asian J Surg 2017; 40 (03) 227-231
  • 42 Maleux G, Pirenne J, Aerts R, Nevens F. Case report: hepatic artery pseudoaneurysm after liver transplantation: definitive treatment with a stent-graft after failed coil embolisation. Br J Radiol 2005; 78 (929) 453-456
  • 43 Muraoka N, Uematsu H, Kinoshita K. , et al. Covered coronary stent graft in the treatment of hepatic artery pseudoaneurysm after liver transplantation. J Vasc Interv Radiol 2005; 16 (2 Pt 1): 300-302
  • 44 Almogy G, Bloom A, Verstandig A, Eid A. Hepatic artery pseudoaneurysm after liver transplantation. A result of transhepatic biliary drainage for primary sclerosing cholangitis. Transpl Int 2002; 15 (01) 53-55
  • 45 Quiroga S, Sebastià MC, Margarit C, Castells L, Boyé R, Alvarez-Castells A. Complications of orthotopic liver transplantation: spectrum of findings with helical CT. Radiographics 2001; 21 (05) 1085-1102
  • 46 Nagaraja R, Govindasamy M, Varma V. , et al. Hepatic artery pseudoaneurysms: a single-center experience. Ann Vasc Surg 2013; 27 (06) 743-749
  • 47 Goldsmith LE, Wiebke K, Seal J. , et al. Complications after endovascular treatment of hepatic artery stenosis after liver transplantation. J Vasc Surg 2017; 66 (05) 1488-1496