Uslu Nihal, Aslan Hulya, Tore Huseyin Gurkan, Moray Gokhan, Karakayali Hamdi, Boyvat Fatih, Arslan Gulnaz, Haberal Mehmet
Department of Radiology, Baskent University Faculty of Medicine, Ankara, Turkey.
Exp Clin Transplant. 2012 Aug;10(4):363-7. doi: 10.6002/ect.2012.0007. Epub 2012 Jul 3.
Splenic arterial steal syndrome is an important cause of morbidity and mortality after orthotopic liver transplant. Splenic arterial steal syndrome is characterized by arterial hypoperfusion of the graft; and if left untreated, causes ischemic biliary tract injury. Selective arterial embolization is important when treating splenic arterial steal syndrome. Doppler ultrasound has been used to follow-up liver transplant patients. This study sought to analyze alterations in portal vein velocity, peak systolic velocity, and resistivity index of the hepatic artery before diagnosis and after treatment of splenic arterial steal syndrome.
We analyzed the Duplex Doppler ultrasonography results of 20 liver transplant recipients who developed angiographically proven splenic arterial steal syndrome between January 2005 and March 2009. Peak systolic velocity and resistivity index of the hepatic artery were noted during transplant surgery, before selective arterial embolization, and after embolization procedures.
A statistically significant decrease was found in peak systolic velocity and resistivity index of the hepatic artery between the intraoperative and pre-embolization values. In contrast to the statistically significant increase in peak systolic velocity of the hepatic artery, there were no significant changes in resistivity index after the selective arterial embolization. Portal vein velocity did not show a statistically significant change between intraoperative and preprocedure values. Portal vein velocity did show a tendency to decrease after coil embolization, but this was not significant.
Doppler ultrasound surveillance is a valuable tool in early detection of hepatic arterial complications. A decrease in peak systolic velocity and resistivity index compared to the corresponding intraoperative data should raise suspicion of splenic arterial steal syndrome. Also Doppler ultrasound can be effectively used to examine the hepatic arterial inflow after selective arterial embolization.
脾动脉盗血综合征是原位肝移植术后发病和死亡的重要原因。脾动脉盗血综合征的特征是移植肝动脉灌注不足；若不治疗，可导致缺血性胆道损伤。选择性动脉栓塞在治疗脾动脉盗血综合征时很重要。多普勒超声已用于肝移植患者的随访。本研究旨在分析脾动脉盗血综合征诊断前及治疗后门静脉速度、肝动脉收缩期峰值速度和阻力指数的变化。
我们分析了20例在2005年1月至2009年3月间经血管造影证实发生脾动脉盗血综合征的肝移植受者的双功多普勒超声检查结果。记录肝动脉收缩期峰值速度和阻力指数在移植手术期间、选择性动脉栓塞前及栓塞术后的情况。
肝动脉收缩期峰值速度和阻力指数在术中与栓塞前的值之间存在统计学上的显著降低。与肝动脉收缩期峰值速度统计学上的显著增加相反，选择性动脉栓塞后阻力指数没有显著变化。门静脉速度在术中与术前值之间没有显示出统计学上的显著变化。门静脉速度在弹簧圈栓塞后确实有降低的趋势，但不显著。
多普勒超声监测是早期发现肝动脉并发症的有价值工具。与相应的术中数据相比，收缩期峰值速度和阻力指数的降低应引起对脾动脉盗血综合征的怀疑。此外，多普勒超声可有效用于检查选择性动脉栓塞后的肝动脉血流。
