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Catheter Thrombolysis of Thrombosed Hepatic Arteries in Liver Transplant Recipients: Predictors of Success and Role of Thrombolysis

Department of Imaging Sciences, Section of Vascular/Interventional Radiology, University of Rochester Medical Center, New York, wspikes{at}yahoo.com

Mark G. Davies, MD, PhD

Department of Surgery, Division of Vascular Surgery, University of Rochester Medical Center, New York

Nael E. A. Saad, MBBCh

Department of Imaging Sciences, Section of Vascular/Interventional Radiology, University of Rochester Medical Center, New York

Karin E. Westesson

School of Medicine and Dentistry, University of Rochester Medical Center, New York

Nikhil C. Patel, MD

Department of Imaging Sciences, Section of Vascular/Interventional Radiology, University of Rochester Medical Center, New York

Lawrence G. Sahler, MD

Department of Imaging Sciences, Section of Vascular/Interventional Radiology, University of Rochester Medical Center, New York

David E. Lee, MD

Department of Imaging Sciences, Section of Vascular/Interventional Radiology, University of Rochester Medical Center, New York

Takashi Kitanosono, MD

Department of Imaging Sciences, Section of Vascular/Interventional Radiology, University of Rochester Medical Center, New York

Talia Sasson, MD

Department of Imaging Sciences, Section of Vascular/Interventional Radiology, University of Rochester Medical Center, New York

David L. Waldman, MD, PhD

Department of Imaging Sciences, Section of Vascular/Interventional Radiology, University of Rochester Medical Center, New York

Hepatic artery thrombosis is an uncommon complication of liver transplantation. However, it is a major indication for re-transplantation. The use of transcatheter thrombolysis and subsequent surgical revascularization as a graft salvage procedure is discussed. Four of 5 cases (80%) were successful in re-establishing flow and uncovering underlying arterial anatomic defects. None were treated definitively by endoluminal measures due to an inability to resolve the underlying anatomic defects. However, 2 of 5 cases (40%) went on to a successful surgical revascularization and represent successful long-term outcome of transcatheter thrombolysis followed by definitive surgical revascularization. We conclude that, definitive endoluminal success cannot be achieved without resolving associated, and possibly instigating, underlying arterial anatomical defects. However, reestablishing flow to the graft can unmask underlying lesions as well as asses surrounding vasculature thus providing anatomical information for a more elective, better planned and definitive surgical revision.

Key Words: hepatic artery • stenosis • thrombosis • thrombolysis • angioplasty • liver transplant

Vascular and Endovascular Surgery, Vol. 41, No. 1, 19-26 (2007)
DOI: 10.1177/1538574406296210


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