Yoshiya Shohei, Yoshizumi Tomoharu, Iseda Norifumi, Takeishi Kazuki, Toshima Takeo, Nagao Yoshihiro, Itoh Shinji, Harada Noboru, Ikegami Toru, Mori Masaki
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Transplant Proc. 2020 Mar;52(2):641-643. doi: 10.1016/j.transproceed.2019.12.003. Epub 2020 Feb 5.
Hepatic artery occlusion (HAO) is a life-threatening complication after liver transplantation. We report a case of portal vein arterialization (PVA) with anastomosis of the recipient common hepatic artery (CHA) and a graft of the round ligament to achieve intrahepatic arterial flow.
A 57-year-old man had a medical history of decompensated liver cirrhosis secondary to cholestatic liver disease owing to biliary anastomotic stricture after living donor liver transplantation and end-stage renal failure. He underwent deceased donor liver and renal transplantation with anastomosis of the recipient proper hepatic artery and the graft CHA. He experience symptoms from HAO on postoperative day 23 and underwent emergency surgery to re-anastomose the hepatic artery. Despite several instances of re-anastomoses, intrahepatic arterial flow was not able to be achieved and therefore PVA with anastomosis of the recipient CHA and the graft round ligament was performed. Although liver enzyme levels rapidly declined after surgery and the finding of liver infarction was not observed, a large amount of watery stool was observed owing to portal hypertension, which was an adverse effect of PVA. As enhanced computed tomography on POD 31 showed a pseudoaneurysm of the anastomotic site, occlusion with coils was performed to arrest hemorrhage, and a contrast study after coil occlusion showed intrahepatic arterial blood flow via collateral arteries. Thereafter, the patient needed treatment for ischemic biliary duct stenosis and was discharged home on POD 98.
PVA using a round ligament for HAO after liver transplantation might play a role as a bridge treatment until retransplantation or maturation of collaterals.
肝动脉闭塞（HAO）是肝移植术后一种危及生命的并发症。我们报告一例通过受体肝总动脉（CHA）与圆韧带移植物吻合实现门静脉动脉化（PVA）以建立肝内动脉血流的病例。
一名57岁男性，有因活体肝移植术后胆道吻合口狭窄继发胆汁淤积性肝病导致的失代偿期肝硬化病史以及终末期肾衰竭病史。他接受了尸体供肝和肾移植，受体肝固有动脉与供肝CHA进行了吻合。术后第23天他出现了HAO相关症状，并接受了急诊手术重新吻合肝动脉。尽管多次进行了重新吻合，但仍未能实现肝内动脉血流，因此进行了受体CHA与供肝圆韧带吻合的PVA手术。虽然术后肝酶水平迅速下降且未观察到肝梗死，但由于PVA的不良反应门静脉高压，观察到大量水样便。术后第31天的增强计算机断层扫描显示吻合部位有假性动脉瘤，遂进行了弹簧圈栓塞以止血，弹簧圈栓塞后的造影研究显示通过侧支动脉有肝内动脉血流。此后，患者需要治疗缺血性胆管狭窄，并于术后第98天出院回家。
肝移植术后使用圆韧带进行PVA治疗HAO可能在再次移植或侧支循环成熟之前起到桥梁治疗的作用。
