J.Jpn. Surg. Soc.. 105(6): 364-368, 2004

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Feature topic

APPLICATION OF INTERVENTIONAL RADIOLOGY FOR STENOSIS OF VASCULAR ANASTOMOSIS IN LIVING-DONOR LIVER TRANSPLANTATION

Stenosis of vascular anastomosis is a significant complication leading to graft loss after liver transplantation. For the diagnosis of portal vein stenosis, clinical signs of portal hypertension such as ascites and thrombocytopenia,stenosis and/or poststenotic dilatation on ultrasonography(US), and jet flow, rambling, or scarcity flow of the intrahepatic portal vein on Doppler US are useful. Three-dimensional computed tomography is used to confirm the indications for interventional radiography(IVR) to treat portal stenosis.
For the diagnosis of hepatic vein stenosis, clinical signs such as ascites and slight jaundice,dilatation and stenosis on US, and reduced flow with a flat wave form of the intrahepatic portal vein on Doppler US are useful. The percutaneous transcaval approach is safer than the percutaneous transhepatic approach for patients with ascites. The requirement for multiple procedures could be a good indication for stent placement before patients develop liver cirrhosis.
For hepatic artery stenosis,percutaneous intraluminal angioplasty and stenting are possible and good results have been reported recently. However, the long-term results must be evaluated in the future.
IVR can be safely and successfully applied to the treatment of vascular complications using balloon dilatation and/or stent placement techniques before graft dysfunction becomes irreversible.

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