Percutaneous Transhepatic Stent Placement for Hepatic Venous Outflow Obstruction After Liver Transplantation: A Case...

Hepatic venous outflow obstruction (HVOO) is a serious complication after liver transplantation, and endovascular/vascular intervention is an effective treatment option. Most IR procedures for HVOO are performed via transjugular or transfemoral venous approaches, while the use of the percutaneous transhepatic approach has rarely been reported. Here, we report a case of percutaneous transhepatic hepatic vein stent placement for HVOO after living donor liver transplantation (LDLT). A woman in her 50s who had undergone living donor liver transplantation two years ago was admitted to our hospital with weight gain and massive ascites. Contrast-enhanced computed tomography (CT) suggested HVOO, which was confirmed by CT arterial portography. Because selective catheterization of the hepatic vein via transjugular or transfemoral approach was unsuccessful, an ultrasound-guided percutaneous transhepatic approach using a two-step puncture technique with a 21-gauge fine needle was performed. Balloon venoplasty, followed by placement of two self-expanding stents, was performed across the stenotic segment. Hepatic venous outflow was restored immediately without procedure-related complications. Follow-up imaging demonstrated an improvement in hepatic congestion and sustained stent patency. This case highlighted percutaneous transhepatic hepatic vein stent placement as a useful alternative treatment for posttransplant HVOO when standard venous access is difficult.