Duplex Doppler sonography and angiography in the evaluation for liver transplantation

Duplex Doppler sonography (DDS) and angiography were performed in a prospective study comprising 22 adult patients with hepatic failure. The ability of the 2 methods to visualize the different splanchnic vessels was compared, as well as any abnormality in the liver parenchyma and vessels. The purpose of the study was to decide if DDS could replace angiography in the pretransplantation work-up in these patients. The portal vein was correctly identified as open in 20 patients using DDS and in 21 patients at angiography. Portal vein thrombosis in one patient was correctly diagnosed by both methods. The identification of other vascular structures in the upper part of the abdomen, e.g., liver arteries and splenic vein, was demonstrated in 14 and 16 patients respectively at DDS. Hepatoma in one patient was correctly identified by both methods, as well as the presence of ascites. Splenic artery aneurysms were found in 4 patients at angiography, and in none of these was DDS able to show this abnormality. We conclude that abdominal angiography still seems superior to DDS in the evaluation of patients with hepatic failure prior to orthotopic liver transplantation, especially to demonstrate possible splenic artery aneurysms and detailed mapping of the hepatic arteries.