Endovascular Management in Post Liver Transplant Recipients with Venous Anastomotic Site Stenosis and an Associated Iatrogenic Arterio-portal Fistula: Case Series and Review of Literature

Abstract

Venous anastomotic site stenosis is a relatively uncommon but an important complication seen in patients post-liver transplant surgery. These stenosis can occur at hepatic vein, portal vein or Inferior Vena Cava (IVC) anastomotic site and may result in hepatic congestion leading to hepatic dysfunction and massive ascites. Routine Doppler ultrasonography is critical for early detection of these complications and in guiding further management. With the advancement in interventional radiology, most of these complications can now be managed by minimally invasive endovascular methods with successful long term outcome. This case series of three patients (one cadaveric and two live related donor recipient) portrays the role of doppler ultrasonography in post-liver transplant graft surveillance and concludes that ultrasound plays a critical role in early diagnosis of venous anastomotic stenosis. The series also highlights the key role of interventional radiology in treating the stenosis safely and successfully by balloon angioplasty with or without stenting.

Keywords

• balloon angioplasty
• doppler ultrasonography
• embolisation
• portal vein angioplasty