Chronic hepatic artery occlusion with collateral formation: imaging findings and outcomes
S Vaidya1, M Dighe, P Bhargava
1Department of Radiology, University of Washington Medical Center, Seattle, Washington 98195, USA.
Insights
Hepatic arterial collaterals in liver transplant patients are often small and their clinical significance is unclear. Understanding these findings may help avoid unnecessary surgical interventions.
Area of Science:
- Radiology
- Transplant Surgery
- Vascular Imaging
Background:
- Hepatic arterial collaterals can develop in patients post-liver transplantation.
- Assessing the significance of these collaterals is crucial for patient management.
Purpose of the Study:
- To review imaging findings, clinical presentation, and outcomes in liver transplant recipients with hepatic arterial collaterals.
- To determine the clinical significance of hepatic arterial collaterals in this patient population.
Main Methods:
- Retrospective review of adult orthotopic liver transplantation patients who underwent angiography over a 10-year period.
- Correlation of angiographic findings with ultrasound and other imaging studies.
- Analysis of liver function and clinical outcomes at the time of angiography and during follow-up.
Main Results:
- Twenty-four percent of patients (24/129) undergoing angiography for suspected hepatic arterial abnormality demonstrated collaterals.
- The maximum size of observed collaterals was 3 mm.
- While 83% of patients with collaterals were alive, 50% experienced complications, including liver ischemia (41.7%) and post-transplant lymphoproliferative disease (8.3%).
Conclusions:
- Hepatic arterial collaterals in post-liver transplant patients are typically small.
- The clinical significance of these small collaterals remains unclear.
- Recognition of these findings may prevent unnecessary urgent surgical re-exploration or vascular intervention.
Objective:
The imaging findings, clinical presentation, and outcome in post liver transplantation patients with hepatic arterial collaterals are reviewed.
Materials And Methods:
Adult post orthotopic liver transplantation patients who underwent an angiography at our institution for suspected hepatic arterial abnormality during an approximately 10-year period were included in our study. A retrospective review of all cases that had hepatic arterial collaterals detected on angiography was then performed. Angiographic findings were correlated with the findings on ultrasound and other imaging studies. Liver function at the time of angiography was recorded. Clinical outcomes were reviewed.
Results:
Of the 129 angiographies performed in the approximately 10-year period, 24 (19.4%) were found to have collaterals on angiography. Maximum size of the collaterals seen on angiography was 3 mm. Twenty patients (83%) with collaterals are currently alive. Twelve patients (50%) had a normal outcome and did not develop any complications on follow-up; however, the rest developed complications. Eleven patients (41.7%) had complication related to the liver ischemia and 2 patients (8.3%) developed malignancy (posttransplant lymphoproliferative disease).
Conclusion:
Collaterals seen in patients with chronic hepatic artery occlusion are usually small in caliber and their significance is unclear. Recognition and understanding of this phenomenon is important as this subset of patients may not need urgent surgical re-exploration/vascular intervention.