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Safety and Efficacy of Primary Stent Placement for Hepatic Artery Kinks in Liver Transplant Recipients
Vijay Ramalingam1, Ammar Sarwar2, Sheikh Muhammad Usman Shami2
1Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, 02215, USA. vramali1@bidmc.harvard.edu.
Insights
Primary stent placement effectively resolves hepatic artery kinks in liver transplant recipients, maintaining excellent long-term patency. This procedure ensures sustained blood flow, crucial for transplant success.
Area of Science:
- Transplantation Surgery
- Vascular Surgery
- Interventional Radiology
Background:
- Hepatic artery kinks can compromise blood flow in liver transplant recipients.
- Redundancy of the transplanted hepatic artery often leads to acute arterial bends and wall coaptation.
- Effective management of these kinks is vital for graft survival.
Purpose of the Study:
- To assess the long-term efficacy of primary stent placement for managing hepatic artery kinks.
- To evaluate the patency rates of stents used to correct hepatic artery kinks post-liver transplant.
Main Methods:
- Retrospective review of liver transplant recipients who underwent primary stent placement.
- Inclusion criteria: stent placement for hepatic artery kink; exclusion: hepatic artery thrombosis or angioplasty alone.
- Kaplan-Meier analysis used to determine primary patency at 1, 3, and 5 years.
Main Results:
- Fifteen patients underwent stent placement for hepatic artery kinks.
- Primary patency rates were 92% at 1, 3, and 5 years.
- Primary-assisted patency reached 100% at all evaluated time points; one technical failure required re-intervention.
Conclusions:
- Primary stent placement is a highly effective treatment for hepatic artery kinks in liver transplant recipients.
- The procedure demonstrates excellent and durable long-term patency.
- Stenting offers a reliable solution to maintain hepatic artery patency and support graft function.
Purpose:
To evaluate the long-term outcomes of primary stent placement for hepatic artery kinks in liver transplant recipients.
Methods:
After institutional review board approval, all patients undergoing liver transplantation between February 2001 and February 2024 at a single institution who underwent primary stent placement were reviewed. Patients who had hepatic artery thrombosis or underwent balloon angioplasty alone were excluded. Patients who underwent stent placement for hepatic artery kink were included. Hepatic artery kinks were defined by an acute arterial bend with coaptation of the arterial wall which is typically due to redundancy of the transplant hepatic artery. Hepatic arterial patency was evaluated at 1, 3, and 5 years. Kaplan-Meier analysis was performed for primary patency.
Results:
Fifty-six patients underwent hepatic artery stent placement. Further stratification resulted in 15/56 patients undergoing stent placement for hepatic artery kink. Primary patency rates for hepatic artery kink patients (n = 15) at 1, 3, and 5 years were 92%, 92%, and 92%, respectively. Primary-assisted patency for stent placement for hepatic artery kink was 100% at 1, 3, and 5 years. One patient had mid-stent kinking which was categorized as a technical failure and required re-intervention (n = 1/15). No patients had kink propagation or arterial rupture.
Conclusion:
In conclusion, primary stent placement for hepatic artery kink has excellent long-term patency.
