Naidu Sailendra, Alzubaidi Sadeer, Knuttinen Grace, Patel Indravadan, Fleck Andrew, Sweeney John, Aqel Bashar, Larsen Brandon, Buras Matthew, Golafshar Michael, Oklu Rahmi
Division of Vascular & Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
J Clin Med. 2021 Jan 20;10(3):380. doi: 10.3390/jcm10030380.
Hepatic artery stenosis after liver transplant is often treated with endovascular stent placement. Our institution has adopted use of drug-eluting stents, particularly in small-caliber arteries. We aimed to compare patency rates of drug-eluting stents vs. traditional bare-metal stents. This was a single-institution, retrospective study of liver transplant hepatic artery stenosis treated with stents. Primary patency was defined as time from stent placement to resistive index on Doppler ultrasonography (<0.5), hepatic artery thrombosis, or any intervention including surgery. Fifty-two patients were treated with stents (31 men; mean age, 57 years): 15, drug-eluting stents; 37, bare-metal stents. Mean arterial diameters were 4.1 mm and 5.1 mm, respectively. Technical success was 100% (52/52). At 6 months, 1, 2, and 3 years, primary patency for drug-eluting stents was 80%, 71%, 71%, and 71%; bare-metal stents: 76%, 65%, 53%, and 46% ( = 0.41). Primary patency for small-caliber arteries (3.5-4.5 mm) with drug-eluting stents was 93%, 75%, 75%, and 75%; bare-metal stents: 60%, 60%, 50%, and 38% ( = 0.19). Overall survival was 100%, 100%, 94%, and 91%. Graft survival was 100%, 98%, 96%, and 90%. Stenting for hepatic artery stenosis was safe and effective. While not statistically significant, patency improved with drug-eluting stents compared with bare-metal stents, especially in arteries < 4.5 mm in diameter. Drug-eluting stents can be considered for liver transplant hepatic artery stenosis, particularly in small-caliber arteries.
肝移植术后肝动脉狭窄常采用血管内支架置入术治疗。我们机构已采用药物洗脱支架，尤其是在小口径动脉中。我们旨在比较药物洗脱支架与传统裸金属支架的通畅率。这是一项在单一机构进行的对接受支架治疗的肝移植肝动脉狭窄的回顾性研究。主要通畅定义为从支架置入到多普勒超声检查阻力指数（<0.5）、肝动脉血栓形成或包括手术在内的任何干预的时间。52例患者接受了支架治疗（31例男性；平均年龄57岁）：15例使用药物洗脱支架；37例使用裸金属支架。平均动脉直径分别为4.1毫米和5.1毫米。技术成功率为100%（52/52）。在6个月、1年、2年和3年时，药物洗脱支架的主要通畅率分别为80%、71%、71%和71%；裸金属支架为76%、65%、53%和46%（P = 0.41）。小口径动脉（3.5 - 4.5毫米）使用药物洗脱支架的主要通畅率为93%、75%、75%和75%；裸金属支架为60%、60%、50%和38%（P = 0.19）。总体生存率分别为100%、100%、94%和91%。移植物生存率分别为100%、98%、96%和90%。肝动脉狭窄的支架置入术安全有效。虽然无统计学意义，但与裸金属支架相比，药物洗脱支架的通畅率有所提高，尤其是在直径<4.5毫米的动脉中。肝移植肝动脉狭窄可考虑使用药物洗脱支架，尤其是在小口径动脉中。
