Dipartimento di Radiologia e Radiologia Interventistica, IRCCS Azienda Ospedaliera ed Universitaria San Martino, IST-Istituto Nazionale per la Ricerca sul Cancro, Monoblocco 1-Fondi, Largo Rosanna Benzi 10, 16132, Genoa, Italy,
Radiol Med. 2014 Mar;119(3):183-8. doi: 10.1007/s11547-013-0325-4. Epub 2013 Dec 20.
This study was undertaken to evaluate primary stenting in patients with inferior vena cava torsion after orthotopic liver transplantation performed with modified piggyback technique.
From November 2003 to October 2010, six patients developed clinical, laboratory and imaging findings suggestive of caval stenosis, after a mean period of 21 days from an orthotopic liver transplantation performed with modified piggyback technique. Vena cavography showed stenosis due to torsion of the inferior vena cava at the anastomoses and a significant caval venous pressure gradient. All patients were treated with primary stenting followed by in-stent angioplasty in three cases.
In all patients, the stents were successfully positioned at the caval anastomosis and the venous gradient pressure fell from a mean value of 10 to 2 mmHg. Signs and symptoms resolved in all six patients. One patient died 3 months after stent placement due to biliary complications. No evidence of recurrence or complications was noted during the follow-up (mean 49 months).
Primary stenting of inferior vena cava stenosis due to torsion of the anastomoses in patients receiving orthotopic liver transplantation with modified piggyback technique is a safe, effective and durable treatment.
本研究旨在评估改良背驮式肝移植术后下腔静脉扭转患者的初次支架置入治疗效果。
2003 年 11 月至 2010 年 10 月，6 例患者在改良背驮式肝移植术后 21 天出现下腔静脉吻合口扭转导致狭窄的临床、实验室和影像学表现，下腔静脉造影显示吻合口狭窄，下腔静脉压力梯度显著升高。所有患者均采用初次支架置入治疗，其中 3 例随后进行了支架内血管成形术。
所有患者的支架均成功定位在下腔静脉吻合口，静脉压力梯度从平均 10mmHg 降至 2mmHg。所有 6 例患者的症状和体征均得到缓解。1 例患者在支架置入 3 个月后因胆系并发症死亡。在平均 49 个月的随访中，未发现再狭窄或并发症的证据。
改良背驮式肝移植术后下腔静脉吻合口扭转导致狭窄的初次支架置入是一种安全、有效且持久的治疗方法。
