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Published on: April 8, 2018
Diagnosis and Management of Hepatic Artery Complications After Liver Transplantation
F Frongillo1, M C Lirosi1, E Nure1
1Department of Surgery, Transplantation Service, Catholic University of the Sacred Heart, Policlinico "A. Gemelli," Largo A. Gemelli, Rome, Italy.
Insights
Color Doppler ultrasound effectively diagnoses hepatic artery complications after liver transplantation. Tardus-parvus waveforms indicate severe arterial issues, improving diagnostic accuracy and guiding timely treatment.
Area of Science:
- Transplant Surgery
- Vascular Imaging
- Hepatology
Background:
- Hepatic artery complications are a significant concern following liver transplantation.
- Early and accurate diagnosis is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the utility of color Doppler ultrasound in diagnosing and monitoring hepatic artery complications post-liver transplant.
- To assess the significance of specific Doppler waveform patterns in identifying these complications.
Main Methods:
- A retrospective analysis of 421 liver transplant recipients.
- Serial ultrasound (US) color Doppler evaluations of hepatic arteries were performed post-surgery.
- Correlation with computed tomography angiography in select cases.
Main Results:
- Identified 4 types of hepatic artery complications, including thrombosis, stenosis, kinking, and pseudo-aneurysm.
- Absence of Doppler signals indicated early thrombosis; tardus-parvus waveforms suggested late thrombosis or stenosis.
- Indirect signs like tardus-parvus waveforms enhanced diagnostic accuracy for stenosis and thrombosis.
Conclusions:
- Ultrasound color Doppler is valuable for early detection of hepatic artery complications after liver transplantation.
- Tardus-parvus waveforms are reliable indicators of severe hepatic artery perfusion impairment.
- Prompt diagnosis using these methods should guide therapeutic interventions.
Background:
We assessed the usefulness of color Doppler imaging in diagnosis and monitoring hepatic artery complications after liver transplantation.
Methods:
Subjects were 421 liver transplant recipients who underwent serial ultrasound (US) color Doppler evaluations of the hepatic arteries after surgery.
Results:
We saw 4 hepatic arterial complications after liver transplantation (13 thrombosis, 29 stenosis, 2 kinking, 2 pseudo-aneurysm, and 2 pseudo-aneurysm rupture). All subjects underwent US color Doppler examination periodically after surgery. In 6 cases of early thrombosis, hepatic arterial obstruction was diagnosed with absence of Doppler signals; in the other 7 cases (late hepatic artery thrombosis), thrombosis was suspected for the presence of intra-parenchymal "tardus-parvus" waveforms. In all of the cases, computed tomography angiography showed obstruction of the main arterial trunk and the development of compensatory collateral circles (late hepatic artery thrombosis). In 10 of the 29 cases of stenosis, Doppler ultrasonography examination revealed stenotic tract and intra-hepatic tardus-parvus waveforms; in 17 stenosis cases, the site of stenosis could not be identified, but intra-parenchymal tardus-parvus waveforms were recorded. In 2 patients, hepatic artery stenosis occurred with ischemic complications.
Conclusions:
The use of US color Doppler examination allows the early diagnosis of hepatic arterial complications after liver transplantation. Tardus-parvus waveforms indicated severe impairment of hepatic arterial perfusion from either thrombosis or severe stenosis. The presence of these indirect signs enhanced the accuracy of color Doppler diagnosis, and detection should prompt therapy.
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