Primary Stent Angioplasty of the Inferior Vena Cava After Liver Transplantation and Liver Resection
Tóm tắt
This study evaluated technical efficacy and safety of stent angioplasty of the inferior vena cava (IVC) after liver transplantation or liver resection and analysis of changes in creatinine levels and patients’ weight.
Between October 2004 and February 2011, 16 patients (mean age, 52.6 years) with symptomatic IVC stenoses after liver transplantation (n = 10) or liver resection (n = 6) were subjected to stent angioplasty. Enrollment criteria included edema and/or ascites. The smallest diameter of the IVC, serum creatinine values, and patients’ weight were assessed before and after stent placement and respective values were compared. Technical and clinical success, patency rates, related complications, and patients’ survival were analyzed. Stent placement was technically successful in 16 patients (100 %). Clinical success was achieved in 13 patients (81.25 %), reflecting two patients with early restenosis and one patient suffering from thrombosis distal to the stent. Mean follow-up was 372 days. Primary patencies were 75 % (n = 12). Primary assisted patencies were 93.75 % (n = 15). Serum creatinine levels decreased significantly (p = 0.01) from 1.68 mg/dl before to 1.08 mg/dl after stent placement. Patients’ weight decreased (mean 2.1 %). No angioplasty-related complications occurred. Stent angioplasty of the IVC is an effective and safe treatment of stenoses after liver transplantation and resection and has a positive effect on creatinine levels.
Tài liệu tham khảo
Kraus TW, Röhren T, Manner M, Otto G, Kauffmann GW, Herfarth C (1992) Successful treatment of complete inferior vena cava thrombosis after liver transplantation by thrombolytic therapy. Br J Surg 79(6):568–569
Buell JF, Funaki B, Cronin DC, Yoshida A, Perlman MK, Lorenz J, Kelly S, Brady L, Leef JA, Millis JM (2002) Long-term venous complications after full-size and segmental pediatric liver transplantation. Ann Surg 236(5):658–666
Zajko AB, Sheng R, Bron K, Reyes J, Nour B, Tzakis A (1994) Percutaneous transluminal angioplasty of venous anastomotic stenoses complicating liver transplantation: intermediate-term results. J Vasc Interv Radiol 5(1):121–126
Darcy MD (2007) Management of venous outflow complications after liver transplantation. Tech Vasc Interv Radiol 10(3):240–245
Saeb-Parsy K, Jah A, Butler AJ, Large S, Pettigrew GJ, Praseedom RK, Watson CJ, Jamieson NV (2009) Use of donor aortic interposition allograft to treat stenosis of the suprahepatic inferior vena cava after liver transplantation. Liver Transpl 15(6):662–665
Raby N, Karani J, Thomas S, O’Grady J, Williams R (1991) Stenoses of vascular anastomoses after hepatic transplantation: treatment with balloon angioplasty. AJR Am J Roentgenol 157(1):167–171
Lee JM, Ko GY, Sung KB, Gwon DI, Yoon HK, Lee SG (2010) Long-term efficacy of stent placement for treating inferior vena cava stenosis following liver transplantation. Liver Transpl 16(4):513–519
Borsa JJ, Daly CP, Fontaine AB, Patel NH, Althaus SJ, Hoffer EK, Winter TC, Nghiem HV, McVicar JP (1999) Treatment of inferior vena cava anastomotic stenoses with the Wallstent endoprosthesis after orthotopic liver transplantation. J Vasc Interv Radiol 10(1):17–22
Weeks SM, Gerber DA, Jaques PF, Sandhu J, Johnson MW, Fair JH, Mauro MA (2000) Primary Gianturco stent placement for inferior vena cava abnormalities following liver transplantation. J Vasc Interv Radiol 11(2 Pt 1):177–187
Guimarães M, Uflacker R, Schönholz C, Hannegan C, Selby JB (2005) Stent migration complicating treatment of inferior vena cava stenosis after orthotopic liver transplantation. J Vasc Interv Radiol 16(9):1247–1252
Uller W, Knoppke B, Schreyer AG, Heiss P, Schlitt HJ, Melter M, Stroszczynski C, Zoger N, Wohlgemuth WA (2013) Interventional radiological treatment of perihepatic vascular stenosis or occlusion in pediatric patients after liver transplantation. Cardiovasc Interv Radiol. doi:10.1007/s00270-013-0595-1
Kishi K, Sonomura T, Fujimoto H, Kimura M, Yamada K, Sato M, Juri M (2006) Physiologic effect of stent therapy for inferior vena cava obstruction due to malignant liver tumor. Cardiovasc Interv Radiol 29(1):75–83