Boyvat F, Aytekin C, Karakayali H, Ozyer U, Sevmis S, Emiroğlu R, Haberal M
Department of Radiology, Baskent University, Ankara, Turkey.
Transplant Proc. 2006 Dec;38(10):3656-60. doi: 10.1016/j.transproceed.2006.10.169.
Hepatic artery stenosis (HAS) and thrombosis (HAT) after orthotopic liver transplantation remain significant causes of graft loss. Postoperative HAT follows approximately 5% to 19% of orthotopic liver transplantation. It is seen more frequently in pediatric patients. In the past, repeat transplantation was considered the first choice for therapy. Recently, interventional radiological techniques, such as thrombolysis, percutaneous transluminal angioplasty, or stent placement in the hepatic artery, have been suggested, but little data exist related to stent placement in the thrombosed hepatic artery during the early postoperative period in pediatric patients. Between March 2000 and March 2005, percutaneous endoluminal stent placement was performed in seven pediatric liver transplant patients. HAT or HAS initially diagnosed in all cases by Doppler ultrasound then confirmed angiographically. We intervened in four cases of hepatic artery stenosis and three cases of hepatic artery occlusion. Stents were placed in all patients. Three ruptures were seen during percutaneous transluminal angioplasty of the hepatic artery using a covered coronary stents on the first, fifth day, or 17th postoperative day. In one patient, dissection of the origin of the common hepatic artery developed owing to a guiding sheath, and a second stent was placed to cover the dissected segment. The other two hepatic artery stents remained patent. In one stent became occluded at 3 months after the intervention with no clinical problems. Follow-up ranged from 9 to 40 months. In conclusion, early and late postoperative stent placement in the graft hepatic artery was technically feasible.
原位肝移植术后肝动脉狭窄（HAS）和血栓形成（HAT）仍然是移植物丢失的重要原因。术后HAT发生率约为原位肝移植的5%至19%。在儿科患者中更为常见。过去，再次移植被认为是首选治疗方法。最近，有人提出采用介入放射技术，如溶栓、经皮腔内血管成形术或肝动脉支架置入术，但关于儿科患者术后早期在血栓形成的肝动脉中置入支架的数据很少。2000年3月至2005年3月期间，对7例儿科肝移植患者进行了经皮腔内支架置入术。所有病例最初均通过多普勒超声诊断为HAT或HAS，然后通过血管造影确诊。我们对4例肝动脉狭窄和3例肝动脉闭塞进行了干预。所有患者均置入了支架。在术后第1天、第5天或第17天使用覆膜冠状动脉支架对肝动脉进行经皮腔内血管成形术期间，观察到3例破裂。1例患者因引导鞘导致肝总动脉起始部夹层形成，置入第二个支架以覆盖夹层段。另外两个肝动脉支架保持通畅。1个支架在干预后3个月闭塞，但无临床问题。随访时间为9至40个月。总之，在移植肝动脉中早期和晚期置入支架在技术上是可行的。
