Stenoses of vascular anastomoses after hepatic transplantation: treatment with balloon angioplasty.

Vascular complications after liver transplantation include occlusion or stenosis at the sites of anastomosis in the hepatic artery, portal vein, and vena cava. From our experience with more than 600 liver transplants, vascular stenoses have been identified in 10 patients and treated by balloon angioplasty in nine. Three patients with hepatic artery stenosis and deteriorating graft function were treated by balloon angioplasty with a coaxial technique. A specially designed catheter facilitated a successful femoral artery approach. Portal vein stenoses in three patients resulted in portal hypertension. These were treated by balloon dilatation via transhepatic catheterization of the portal vein. Stenoses of the suprahepatic caval anastomosis were dilated in three patients with severe lower limb edema. Technical success was achieved in all three cases of hepatic artery stenosis with improvement in graft function. Recurrent stenoses in two patients were successfully treated with repeated dilatations. Portal hypertension resolved in two of three patients after portal venoplasty. Dilatation of a caval stenosis resulted in the resolution of leg edema in all three cases. Repeated dilatation was required in one case. No reduction in the portal venous pressure gradient occurred after venoplasty in one case, and an ultimately fatal caval thrombosis developed in one patient with caval stenosis before venoplasty could be performed. Our experience suggests that balloon angioplasty of arterial and venous stenoses complicating hepatic transplantation carries little risk and is a useful procedure for the treatment of these problems.