Narasimham L. Dasika MD, Presenter: Nothing to Disclose

Shawn Pelletier MD, Abstract Co-Author: Nothing to Disclose

David Matthew Williams MD, Abstract Co-Author: Nothing to Disclose

Evaluation and endovascular treatment of acute and chronic venous outflow obstruction in Orthotopic Liver Transplant recipients and follow-up to evaluate long term complications from hepatic vein stenting. 

All patients that had endovascular stent placement for post transplant veonous outflow obstruction in the past 12 years were retrospectively analyzed for angiographic and pressure gradient abnormalities, graft survival, Intra procedural stent related, and long term stent related complications including the effect on retransplantation when retransplanted. All patients that responded to balloon angioplasty alone were excluded from the study,

Forty six patients were treated with hepatic vein and/or IVC stent placement to relieve HV outflow obstruction. The highest incidence of venous anastomotic abnormalities is seen with Piggyback anastomsis. Mean follow-up is 36 months with a range of 1 day to 8 years. HV outflow obstruction was noted immediately after transplantation (n=5), within 30 days (n=21) and delayed in the remaining patients. A residual gradient of greater than 10mm or more of Hg even after balloon dilation was noted between the HV and right atrium in the treated patients. Thrombosis and portal vein filling on free hepatic venogram were noted from acute torsion of the liver (n=6) following piggyback anastomosis. Pulse spray thrombolysis was performed in the immediate post operative period in 5 patients. Two intraprocedural procedural mortalities were noted. Stent migrated into right atrium requiring removal by thoracotomy (n=1). Most patients (n=28) had graft survival of more than 1 year. In one of the retransplanted patients the stent could not be taken out and the new anastomosis was made caudal to the stent.

Relief of venous outflow obstruction, improvement in symptoms and restoration of donor liver function can be achieved by Hepatic vein and/or simultaneous IVC stent placement. Graft survival is achieved in majority of the patients. Proper anatomical and physiological evaluation of HV and IVC to pin point the exact level of obstruction is essential to select the size and location of the stent deployment and to prevent complications. Retransplantation is possible in stented patients.

Treatment of HV outflow obstruction with stenting of HV and IVC requires careful physiological and anatomical evaluation of the graft and is associated with increased graft survival.

Dasika, N, Pelletier, S, Williams, D, Safety, Efficacy, Complications, and Long-term Follow-up of Endovascular Stenting in the Management of Hepatic Venous Outflow Obstruction Following Orthotopic Liver Transplantation (OLT).  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11015471.html