EURORAD ESR

Case 9653

Orthotopic liver transplantation (OLT) complicated with hepatic artery stenosis (HAS)

Author(s)
Scalise P, Pancrazi F, Angelini G, Accogli S, Bozzi E, Turini F, Arena C, Perrone O, Bemi P, Cioni R, Bartolozzi C.

Department of Diagnostic and Interventional Radiology, University Hospital of Pisa, Italy
 
Patient
male, 63 year(s)
 
 
  • Figure 1
    Pre-treatment CDUS
     

    Pre-treatment CDUS shows HA stenosis, turbulent flow in pre-stenotic tract and low resistive (0.47) and pulsatility (0.68) index.

     
    Area of Interest: Liver; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Diagnostic procedure; Special Focus: Transplantation;

    Pre-treatment CDUS shows HA stenosis, turbulent flow in post-stenotic tract and low resistive (0.55) and pulsatility (0.78) index.

     
    Area of Interest: Liver; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Diagnostic procedure; Special Focus: Transplantation;
     
     
  • Figure 2
    Pre-treatment CT angiography
     

    Pre-treatment CT (MIP reconstruction) shows a post-anastomotic pre-dichotomic HAS extending to the proximal part of the left HA branch, 7mm distal to the gastroduodenal artery take-off.

     
    Area of Interest: Liver; Imaging Technique: CT-Angiography; Procedure: Computer Applications-3D; Special Focus: Transplantation;

    Pre-treatment CT (VR reconstruction) shows a post-anastomotic pre-dichotomic HAS extending to the proximal part of the left HA branch, 7mm distal to the gastroduodenal artery take-off.

     
    Area of Interest: Liver; Imaging Technique: CT-Angiography; Procedure: Computer Applications-3D; Special Focus: Transplantation;
     
     
  • Figure 3
    Selective Hepatic Artery Angiography
     

    Selective hepatic artery angiography confirmed the presence of HAS; PTA and loco-regional fibrinolysis were performed in order to restore flow in HA/intrahepatic branches.

     
    Area of Interest: Interventional vascular; Imaging Technique: Percutaneous; Procedure: Recanalisation; Special Focus: Transplantation;

    Selective hepatic artery angiography confirmed the presence of HAS; PTA and loco-regional fibrinolysis were performed in order to restore flow in HA/intrahepatic branches.

     
    Area of Interest: Interventional vascular; Imaging Technique: Percutaneous; Procedure: Recanalisation; Special Focus: Transplantation;

    Selective hepatic artery angiography confirmed the presence of HAS; PTA and loco-regional fibrinolysis were performed in order to restore flow in HA/intrahepatic branches.

     
    Area of Interest: Interventional vascular; Imaging Technique: Percutaneous; Procedure: Recanalisation; Special Focus: Transplantation;

    Post-procedural angiogram showing blood flow restoration in HA/intrahepatic branches. An imaging defect attributable to caliber disproportion between recipient and donor HA persists, but a better result from...

     
    Area of Interest: Interventional vascular; Imaging Technique: Percutaneous; Procedure: Recanalisation; Special Focus: Transplantation;
     
     
  • Figure 4
    Post-treatment CDUS
     

    Despite the minimal reduction in caliber, post-procedural CDUS shows graft regular perfusion and HA patency, with good functional result (left HA intrahepatic branches, RI: 0.51).

     
    Area of Interest: Liver; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Diagnostic procedure; Special Focus: Transplantation;

    Despite the minimal reduction in caliber, post-procedural CDUS shows graft regular perfusion and HA patency, with good functional result (right HA intrahepatic branches, RI: 0.64).

     
    Area of Interest: Liver; Imaging Technique: Ultrasound-Colour Doppler; Procedure: Diagnostic procedure; Special Focus: Transplantation;
     
     
  • Figure 5
    Follow-up CT
     

    At 1-year follow-up CT angiography shows HA patency and absence of restenosis.

     
    Area of Interest: Liver; Imaging Technique: CT-Angiography; Procedure: Recanalisation; Special Focus: Transplantation;

    At 1-year follow-up CT angiography shows HA patency and absence of restenosis.

     
    Area of Interest: Liver; Imaging Technique: CT-Angiography; Procedure: Recanalisation; Special Focus: Transplantation;
     
     
Pre-treatment CDUS shows HA stenosis, turbulent flow in pre-stenotic tract and low resistive (0.47) and pulsatility (0.68) index.
 
Pre-treatment CDUS shows HA stenosis, turbulent flow in post-stenotic tract and low resistive (0.55) and pulsatility (0.78) index.
 
Pre-treatment CT (MIP reconstruction) shows a post-anastomotic pre-dichotomic HAS extending to the proximal part of the left HA branch, 7mm distal to the gastroduodenal artery take-off.
 
Pre-treatment CT (VR reconstruction) shows a post-anastomotic pre-dichotomic HAS extending to the proximal part of the left HA branch, 7mm distal to the gastroduodenal artery take-off.
 
Selective hepatic artery angiography confirmed the presence of HAS; PTA and loco-regional fibrinolysis were performed in order to restore flow in HA/intrahepatic branches.
 
Selective hepatic artery angiography confirmed the presence of HAS; PTA and loco-regional fibrinolysis were performed in order to restore flow in HA/intrahepatic branches.
 
Selective hepatic artery angiography confirmed the presence of HAS; PTA and loco-regional fibrinolysis were performed in order to restore flow in HA/intrahepatic branches.
 
Post-procedural angiogram showing blood flow restoration in HA/intrahepatic branches. An imaging defect attributable to caliber disproportion between recipient and donor HA persists, but a better result from angiographic point of view was not achievable.
 
Despite the minimal reduction in caliber, post-procedural CDUS shows graft regular perfusion and HA patency, with good functional result (left HA intrahepatic branches, RI: 0.51).
 
Despite the minimal reduction in caliber, post-procedural CDUS shows graft regular perfusion and HA patency, with good functional result (right HA intrahepatic branches, RI: 0.64).
 
At 1-year follow-up CT angiography shows HA patency and absence of restenosis.
 
At 1-year follow-up CT angiography shows HA patency and absence of restenosis.
 
 
 
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