Management of Venous Outflow Complications After Liver Transplantation

Liver transplantation can be complicated by stenosis of the hepatic venous or inferior vena cava outflow. Venous outflow stenosis occurs at rates of 1 to 6% depending on the type of anastomosis. Stenoses can develop acutely as a result of technical problems or can present much later after the transp...

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Bibliographic Details
Published in:Techniques in vascular and interventional radiology 2007-09, Vol.10 (3), p.240-245
Main Author: Darcy, Michael D., MD
Format: Article
Language:English
Subjects:
Angioplasty, Balloon - methods
Constriction, Pathologic - diagnosis
Constriction, Pathologic - etiology
Constriction, Pathologic - therapy
Hematology, Oncology and Palliative Medicine
hepatic transplantation
Hepatic Veins - diagnostic imaging
Hepatic Veins - pathology
Humans
Liver Transplantation - adverse effects
Magnetic Resonance Imaging
Postoperative Complications - diagnosis
Postoperative Complications - etiology
Postoperative Complications - therapy
Radiology
Stents
Tomography, X-Ray Computed
Ultrasonography, Doppler
Vena Cava, Inferior
venous anastomotic stenosis
venous angioplasty
venous stenting
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Summary:Liver transplantation can be complicated by stenosis of the hepatic venous or inferior vena cava outflow. Venous outflow stenosis occurs at rates of 1 to 6% depending on the type of anastomosis. Stenoses can develop acutely as a result of technical problems or can present much later after the transplant due to intimal hyperplasia or perianastomotic fibrosis. Common clinical presentations include hepatic dysfunction, liver engorgement, ascites, abdominal pain, and occasionally variceal bleeding. Treatment can generally be accomplished via a transjugular approach, but percutaneous transhepatic access may be needed when the anastomosis cannot be catheterized from the jugular access. Angioplasty can achieve technical success in restoring anastomotic patency in close to 100% of cases, but restenosis is frequent. Repeat angioplasties may be needed. In adults and pediatric patients with adult sized hepatic veins, stenting may be a better option. Resolution of clinical signs and symptoms is seen in 73 to 100% of cases. Major complications are uncommon, with stent migration being one of the more difficult complications to manage.
ISSN:1089-2516
1557-9808
DOI:10.1053/j.tvir.2007.09.018