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• W4362475039 abstract "•Vascular complication following liver transplantation is seen in around 7–13% of the patients, and early diagnosis and prompt treatment are crucial in management of these patients.•Endovascular management is the preferred in patients with late hepatic artery thrombosis or stenosis, whereas retransplantation, surgical revision, or endovascular management can be considered in patients with early hepatic artery thrombosis or stenosis.•Hepatic artery pseudoaneurysm, arterioportal fistula, splenic artery steal syndrome, and hepatic venous/inferior vena cava complications are often treated by endovascular means.•Endovascular management is also preferred in symptomatic portal vein stenosis, early portal vein thrombosis, and symptomatic late portal vein thrombosis, whereas, surgical revision or retransplantation is preferred in perioperative portal vein thrombosis occurring within 3 days of transplantation.•Indications for transjugular intrahepatic portosystemic shunt (TIPS) remain same in the transplant patients; however, major difference is altered vascular anatomy, for which adjunct techniques may be required to create TIPS. Liver transplantation is the treatment of choice in majority of the patients with end stage liver disease. Vascular complication following liver transplantation is seen in around 7–13% of the patients and is associated with graft dysfunction and high morbidity and mortality. Early diagnosis and prompt treatment are crucial in management of these patients. Advances in interventional radiology have significantly improved the management of vascular complications using minimally invasive percutaneous approach. Endovascular management is preferred in patients with late hepatic artery thrombosis, or stenosis, whereas retransplantation, surgical revision, or endovascular management can be considered in patients with early hepatic artery thrombosis or stenosis. Hepatic artery pseudoaneurysm, arterioportal fistula, and splenic artery steal syndrome are often treated by endovascular means. Endovascular management is also preferred in patients with symptomatic portal vein stenosis, early portal vein thrombosis, and symptomatic late portal vein thrombosis, whereas surgical revision or retransplantation is preferred in patients with perioperative portal vein thrombosis occurring within 3 days of transplantation. Venoplasty with or without stent placement can be considered in patients with hepatic venous outflow tract or inferior vena cava obstruction. Transjugular intrahepatic portosystemic shunt (TIPS) may be required in transplant recipients who develop cirrhosis, often, secondary to disease recurrence, or chronic rejection. Indications for TIPS remain same in the transplant patients; however, major difference is altered vascular anatomy, for which adjunct techniques may be required to create TIPS. Liver transplantation is the treatment of choice in majority of the patients with end stage liver disease. Vascular complication following liver transplantation is seen in around 7–13% of the patients and is associated with graft dysfunction and high morbidity and mortality. Early diagnosis and prompt treatment are crucial in management of these patients. Advances in interventional radiology have significantly improved the management of vascular complications using minimally invasive percutaneous approach. Endovascular management is preferred in patients with late hepatic artery thrombosis, or stenosis, whereas retransplantation, surgical revision, or endovascular management can be considered in patients with early hepatic artery thrombosis or stenosis. Hepatic artery pseudoaneurysm, arterioportal fistula, and splenic artery steal syndrome are often treated by endovascular means. Endovascular management is also preferred in patients with symptomatic portal vein stenosis, early portal vein thrombosis, and symptomatic late portal vein thrombosis, whereas surgical revision or retransplantation is preferred in patients with perioperative portal vein thrombosis occurring within 3 days of transplantation. Venoplasty with or without stent placement can be considered in patients with hepatic venous outflow tract or inferior vena cava obstruction. Transjugular intrahepatic portosystemic shunt (TIPS) may be required in transplant recipients who develop cirrhosis, often, secondary to disease recurrence, or chronic rejection. Indications for TIPS remain same in the transplant patients; however, major difference is altered vascular anatomy, for which adjunct techniques may be required to create TIPS. Liver transplantation (LT) is the treatment of choice in patients with end stage liver disease and is the second most transplanted organ in the United States, after kidney.1Delgado-Moraleda J.J. Ballester-Vallés C. Marti-Bonmati L. Role of imaging in the evaluation of vascular complications after liver transplantation.Insights Imag. 2019 Dec; 10: 78Crossref PubMed Scopus (16) Google Scholar,2Horrow M.M. Huynh M.H.L. Callaghan M.M. Rodgers S.K. Complications after liver transplant related to preexisting conditions: diagnosis, treatment, and prevention.Radiographics. 2020 May; 40: 895-909Crossref PubMed Scopus (12) Google Scholar In recent times, living donor LT has been on the rise, considering reduced wait time compared to deceased donor, and also reduced cold ischemic period of transplanted liver. Vascular complications following LT are not uncommon, with incidence of around 7% for deceased donor LT, and 13% for liver donor LT, and are associated with high incidence of graft loss and mortality.1Delgado-Moraleda J.J. Ballester-Vallés C. Marti-Bonmati L. Role of imaging in the evaluation of vascular complications after liver transplantation.Insights Imag. 2019 Dec; 10: 78Crossref PubMed Scopus (16) Google Scholar Transplant-related complications are classified into early (<1 month) and late (>1 month) complications depending on the interval between LT and occurrence of complication. Majority of the vascular complications occur within 3 months of transplant and often present with nonspecific derangement of liver function. Thus, imaging at immediate postoperative period and at follow-up plays an important role in the diagnosis and management of vascular complications.3Miraglia R. Maruzzelli L. Caruso S. et al.Interventional radiology procedures in adult patients who underwent liver transplantation.World J Gastroenterol. 2009; 15: 684Crossref PubMed Scopus (24) Google Scholar Recent improvement in surgical techniques and perioperative medical management have reduced the morbidity and mortality of the transplant patients, with 1-year survival ranging between 86.9% and 93.8%, and 3-year survival between 78.2% and 90.4%.2Horrow M.M. Huynh M.H.L. Callaghan M.M. Rodgers S.K. Complications after liver transplant related to preexisting conditions: diagnosis, treatment, and prevention.Radiographics. 2020 May; 40: 895-909Crossref PubMed Scopus (12) Google Scholar,4Thornburg B. Katariya N. Riaz A. et al.Interventional radiology in the management of the liver transplant patient: thornburg et al.Liver Transpl. 2017 Oct; 23: 1328-1341Crossref PubMed Scopus (12) Google Scholar Hand in hand, in the recent past, there have been advances in interventional radiology that has significantly improved the management of posttransplant complications, using minimal invasive percutaneous approach, obviating the need for repeat surgery and associated morbidity.5Mehrzad H. Mangat K. The role of interventional radiology in treating complications following liver transplantation.ISRN Hepatol. 2013 Dec 3; 2013: 1-6Crossref Google Scholar In this review, we will discuss common vascular complications following LT (Table 1), their diagnosis, and role of interventional radiology in their management.Table 1Vascular Complications Following Liver Transplantation.Vascular complicationsHepatic artery complications Hepatic artery thrombosis Stenosis Pseudoaneurysm Hepatic artery rupturePortal vein complications Portal vein thrombosis Portal vein stenosis Portal vein steal syndromeArterial portal fistulaInferior vena cava or hepatic vein thrombosis or stenosisSplenic steal syndrome or portal hyper perfusion syndrome Open table in a new tab Doppler ultrasonography (DUS) is widely used for routine postoperative screening following LT and also to diagnose vascular complications. On table, DUS is performed immediately after anastomosis to confirm adequate hepatic perfusion. Follow-up ultrasonography is performed with in 24 h of transplant to rule out vascular complications. DUS is often performed once or twice daily, in posttransplant patients till 5th postoperative day and in patients with clinical suspicion of vascular complications.6Gupta A. Narkhede A. Yadav A.K. Vascular complications after hepatic transplantation: role of interventional radiology in management.in: Mukund A. Basics of Hepatobiliary Interventions [Internet]. Springer Singapore, Singapore2021: 217-233http://link.springer.com/10.1007/978-981-15-6856-5_17Crossref Scopus (1) Google Scholar Common posttransplant findings include periportal edema, edema along the resection margin, perihepatic hematoma, ascites, and right pleural effusion. These usually resolve within first few weeks. Careful assessment of hepatic artery, portal vein, hepatic vein/inferior vena cava (IVC), and biliary anastomoses should be performed.1Delgado-Moraleda J.J. Ballester-Vallés C. Marti-Bonmati L. Role of imaging in the evaluation of vascular complications after liver transplantation.Insights Imag. 2019 Dec; 10: 78Crossref PubMed Scopus (16) Google Scholar Common doppler parameters measured include peak systolic velocity (PSV), systolic upstroke, acceleration time, and resistivity index. Hepatic artery should be evaluated at proper hepatic artery, and right and left intrahepatic segments. Visualization of anastomoses is desired but can be obscured by air shadows during immediate postoperative period. Normal hepatic artery shows variable PSV in immediate postoperative period, steep systolic upstroke, and resistivity index between 0.55 and 0.8. Splenic artery should be evaluated at the hilum, as an internal control to assess hepatic artery, for velocities and resistivity index can be altered with altered systemic hemodynamics, or celiac artery disease. Portal assessment should include main portal vein, and right and left intrahepatic branches. Increased portal vein PSV can be seen in immediate posttransplant period, which gradually normalizes over time. Hepatic veins can show mono-, bi-, or triphasic flow in immediate posttransplant period, which gradually normalizes to triphasic pattern.2Horrow M.M. Huynh M.H.L. Callaghan M.M. Rodgers S.K. Complications after liver transplant related to preexisting conditions: diagnosis, treatment, and prevention.Radiographics. 2020 May; 40: 895-909Crossref PubMed Scopus (12) Google Scholar,6Gupta A. Narkhede A. Yadav A.K. Vascular complications after hepatic transplantation: role of interventional radiology in management.in: Mukund A. Basics of Hepatobiliary Interventions [Internet]. Springer Singapore, Singapore2021: 217-233http://link.springer.com/10.1007/978-981-15-6856-5_17Crossref Scopus (1) Google Scholar, 7Dodd G.D. Memel D.S. Zajko A.B. Baron R.L. Santaguida L.A. Hepatic artery stenosis and thrombosis in transplant recipients: Doppler diagnosis with resistive index and systolic acceleration time.Radiology. 1994 Sep; 192: 657-661Crossref PubMed Google Scholar, 8Crossin J.D. Muradali D. Wilson S.R. US of liver transplants: normal and abnormal.Radiographics. 2003 Sep; 23: 1093-1114Crossref PubMed Google Scholar Contrast-enhanced computed tomography (CECT) should be performed when vascular abnormality is suspected on DUS or when there is impairment of liver function, and ultrasonography is inconclusive. Magnetic resonance imaging (MRI) is performed if there are contraindications to CECT.1Delgado-Moraleda J.J. Ballester-Vallés C. Marti-Bonmati L. Role of imaging in the evaluation of vascular complications after liver transplantation.Insights Imag. 2019 Dec; 10: 78Crossref PubMed Scopus (16) Google Scholar,9Cheng Y.F. Interventional radiology in living donor liver transplant.World J Gastroenterol. 2014; 20: 6221Crossref PubMed Scopus (6) Google Scholar Hepatic artery complications can occur in 4–16% of transplant patients and are associated with high morbidity and mortality.9Cheng Y.F. Interventional radiology in living donor liver transplant.World J Gastroenterol. 2014; 20: 6221Crossref PubMed Scopus (6) Google Scholar Unlike normal liver, transplanted liver has no arterial collateral supply, and hepatic artery is the only arterial supply to biliary system and liver. Therefore, impaired hepatic arterial flow can lead to biliary complications, liver abscess, and graft dysfunction.2Horrow M.M. Huynh M.H.L. Callaghan M.M. Rodgers S.K. Complications after liver transplant related to preexisting conditions: diagnosis, treatment, and prevention.Radiographics. 2020 May; 40: 895-909Crossref PubMed Scopus (12) Google Scholar,6Gupta A. Narkhede A. Yadav A.K. Vascular complications after hepatic transplantation: role of interventional radiology in management.in: Mukund A. Basics of Hepatobiliary Interventions [Internet]. Springer Singapore, Singapore2021: 217-233http://link.springer.com/10.1007/978-981-15-6856-5_17Crossref Scopus (1) Google Scholar Hepatic artery complications are classified into early and late complications depending on the interval between LT and occurrence of complication. Early complications occur within 1 month of transplant and are associated with high incidence of graft dysfunction and mortality. Late complications occur after 1 month of transplant and are often associated with biliary complications.1Delgado-Moraleda J.J. Ballester-Vallés C. Marti-Bonmati L. Role of imaging in the evaluation of vascular complications after liver transplantation.Insights Imag. 2019 Dec; 10: 78Crossref PubMed Scopus (16) Google Scholar,6Gupta A. Narkhede A. Yadav A.K. Vascular complications after hepatic transplantation: role of interventional radiology in management.in: Mukund A. Basics of Hepatobiliary Interventions [Internet]. Springer Singapore, Singapore2021: 217-233http://link.springer.com/10.1007/978-981-15-6856-5_17Crossref Scopus (1) Google Scholar1. Hepatic artery thrombosis (HAT) Hepatic artery thrombosis is the most common vascular complication and can be seen in 3–9% of patients following adult LT, and 11–26% patients following pediatric LT.4Thornburg B. Katariya N. Riaz A. et al.Interventional radiology in the management of the liver transplant patient: thornburg et al.Liver Transpl. 2017 Oct; 23: 1328-1341Crossref PubMed Scopus (12) Google Scholar,6Gupta A. Narkhede A. Yadav A.K. Vascular complications after hepatic transplantation: role of interventional radiology in management.in: Mukund A. Basics of Hepatobiliary Interventions [Internet]. Springer Singapore, Singapore2021: 217-233http://link.springer.com/10.1007/978-981-15-6856-5_17Crossref Scopus (1) Google Scholar The incidence of HAT has declined progressively over the past, with current incidence of around 2–3%. HAT is associated with very high morbidity and mortality, with mortality rate ranging between 27% and 58%, and graft loss rate of 50–60%.4Thornburg B. Katariya N. Riaz A. et al.Interventional radiology in the management of the liver transplant patient: thornburg et al.Liver Transpl. 2017 Oct; 23: 1328-1341Crossref PubMed Scopus (12) Google Scholar, 5Mehrzad H. Mangat K. The role of interventional radiology in treating complications following liver transplantation.ISRN Hepatol. 2013 Dec 3; 2013: 1-6Crossref Google Scholar, 6Gupta A. Narkhede A. Yadav A.K. Vascular complications after hepatic transplantation: role of interventional radiology in management.in: Mukund A. Basics of Hepatobiliary Interventions [Internet]. Springer Singapore, Singapore2021: 217-233http://link.springer.com/10.1007/978-981-15-6856-5_17Crossref Scopus (1) Google Scholar,10Cantrell J. The role of interventional radiology in complications after paediatric liver transplantation.S Afr Med J. 2014 Oct 24; 104: 825Crossref Scopus (2) Google Scholar Risk factors for HAT include surgical technique (iatrogenic), small donor hepatic artery, donor age >60 years, aortic jump graft, hepatic artery stenosis, rejection, ischemic reperfusion injury, coagulation abnormalities, ABO incompatible transfusion, and prior transarterial chemoembolization.3Miraglia R. Maruzzelli L. Caruso S. et al.Interventional radiology procedures in adult patients who underwent liver transplantation.World J Gastroenterol. 2009; 15: 684Crossref PubMed Scopus (24) Google Scholar,5Mehrzad H. Mangat K. The role of interventional radiology in treating complications following liver transplantation.ISRN Hepatol. 2013 Dec 3; 2013: 1-6Crossref Google Scholar DUS is the first-line investigation in the diagnosis of HAT. Parameters to be measures include hepatic artery diameter, PSV, and resistivity index. HAT is associated with absence of flow in hepatic artery, with increased resistivity index proximal to thrombosed segment. In patients with suspected HAT on DUS, CECT is performed to confirm the same (Figure 1).1Delgado-Moraleda J.J. Ballester-Vallés C. Marti-Bonmati L. Role of imaging in the evaluation of vascular complications after liver transplantation.Insights Imag. 2019 Dec; 10: 78Crossref PubMed Scopus (16) Google Scholar,4Thornburg B. Katariya N. Riaz A. et al.Interventional radiology in the management of the liver transplant patient: thornburg et al.Liver Transpl. 2017 Oct; 23: 1328-1341Crossref PubMed Scopus (12) Google Scholar Retransplantation is the treatment of choice for early HAT, however, is limited due to scarcity of donor liver. Surgical revascularization procedures can be done; however, it is difficult to treat extensive intrahepatic thrombosis. Surgical revision is preferred in early HAT occurring within 5 days of transplant, unless comorbidities preclude surgery, when endovascular treatment can be done. Endovascular treatment of HAT in 1st week following transplant carries risk of hepatic artery rupture. Endovascular revascularization is often the first line of treatment in HAT occurring after 1 week of transplant (Figure 1).6Gupta A. Narkhede A. Yadav A.K. Vascular complications after hepatic transplantation: role of interventional radiology in management.in: Mukund A. Basics of Hepatobiliary Interventions [Internet]. Springer Singapore, Singapore2021: 217-233http://link.springer.com/10.1007/978-981-15-6856-5_17Crossref Scopus (1) Google Scholar,11Saad W.E.A. Davies M.G. Saad N.E.A. et al.Catheter thrombolysis of thrombosed hepatic arteries in liver transplant recipients: predictors of success and role of thrombolysis.Vasc Endovasc Surg. 2007 Feb; 41: 19-26Crossref PubMed Scopus (41) Google Scholar, 12Figueras J. Busquets J. Dominguez J. et al.Intra-arterial thrombolysis in the treatment of acute hepatic artery thrombosis after liver transplantation.Transplantation. 1995 May 15; 59: 1356-1357PubMed Google Scholar, 13Naidu S.G. Alzubaidi S.J. Patel I.J. et al.Interventional radiology management of adult liver transplant complications.Radiographics. 2022 Oct; 42: 1705-1723Crossref PubMed Scopus (3) Google Scholar In patients with late onset HAT, when onset of HAT is gradual, collaterals can develop, perfusing the intrahepatic branches of hepatic artery. These patients may not require endovascular intervention.13Naidu S.G. Alzubaidi S.J. Patel I.J. et al.Interventional radiology management of adult liver transplant complications.Radiographics. 2022 Oct; 42: 1705-1723Crossref PubMed Scopus (3) Google Scholar Endovascular treatment for HAT includes intraarterial thrombolysis, with or without balloon angioplasty, and stenting. In comparison with systemic anticoagulation, intraarterial thrombolysis has the advantage of high local thrombolytic concentration, lower thrombolytic dose required, and minimal systemic side effects or hemorrhage risk.11Saad W.E.A. Davies M.G. Saad N.E.A. et al.Catheter thrombolysis of thrombosed hepatic arteries in liver transplant recipients: predictors of success and role of thrombolysis.Vasc Endovasc Surg. 2007 Feb; 41: 19-26Crossref PubMed Scopus (41) Google Scholar,14Singhal A. Stokes K. Sebastian A. Wright H.I. Kohli V. Endovascular treatment of hepatic artery thrombosis following liver transplantation.Transplant International. 2010 Mar; 23: 245-256Crossref PubMed Scopus (104) Google Scholar,15Abdelaziz O. Hosny K. Amin A. Emadeldin S. Uemoto S. Mostafa M. Endovascular management of early hepatic artery thrombosis after living donor liver transplantation: endovascular management of early hepatic artery thrombosis after LDLT.Transpl Int. 2012 Aug; 25: 847-856Crossref PubMed Scopus (29) Google Scholar For endovascular procedure, femoral artery access is commonly achieved using 5F or 6F sheath. Guide catheter or sheath is placed in celiac artery or at the origin of common femoral artery, through which microcatheter and guidewire is coaxially introduced to selectively catheterize hepatic artery; 0.014 or 0.018 system is used to reduce the risk of vasospasm and arterial injury. Additionally, intra-arterial nitroglycerin through the guide catheter reduces the risk of vasospasm. Angiogram is taken to confirm the diagnosis. After crossing the occlusion, multiple side hole catheter is then placed across the thrombosed segment for continuous infusion of thrombolytic agent, either recombinant tissue plasminogen activator (0.5–1 U/hour, maximum dose of 24 U/day) or urokinase. If occlusion cannot be crossed, single end hole catheter can be placed just proximal to thrombosis, for thrombolytic infusion. Heparin can be simultaneously infused (1000 U/hour) through the vascular access sheath. Angiography is repeated after 24 h to look for resolution of thrombosis. Decision for continuation of thrombolytic therapy is taken based on the angiographic findings. In case of persistent thrombosis or narrowing, angioplasty and/or stenting can be considered.6Gupta A. Narkhede A. Yadav A.K. Vascular complications after hepatic transplantation: role of interventional radiology in management.in: Mukund A. Basics of Hepatobiliary Interventions [Internet]. Springer Singapore, Singapore2021: 217-233http://link.springer.com/10.1007/978-981-15-6856-5_17Crossref Scopus (1) Google Scholar,13Naidu S.G. Alzubaidi S.J. Patel I.J. et al.Interventional radiology management of adult liver transplant complications.Radiographics. 2022 Oct; 42: 1705-1723Crossref PubMed Scopus (3) Google Scholar,16Škegro D. Percutaneous endovascular treatment for hepatic artery stenosis after liver transplantation: the role of percutaneous endovascular treatment.Pol J Radiol. 2015; 80: 309-316Crossref PubMed Scopus (12) Google Scholar2. Hepatic artery stenosis (HAS) Hepatic artery stenosis is seen in 4–11% of the transplant patients, and is more common at the site of anastomoses.1Delgado-Moraleda J.J. Ballester-Vallés C. Marti-Bonmati L. Role of imaging in the evaluation of vascular complications after liver transplantation.Insights Imag. 2019 Dec; 10: 78Crossref PubMed Scopus (16) Google Scholar,4Thornburg B. Katariya N. Riaz A. et al.Interventional radiology in the management of the liver transplant patient: thornburg et al.Liver Transpl. 2017 Oct; 23: 1328-1341Crossref PubMed Scopus (12) Google Scholar,6Gupta A. Narkhede A. Yadav A.K. Vascular complications after hepatic transplantation: role of interventional radiology in management.in: Mukund A. Basics of Hepatobiliary Interventions [Internet]. Springer Singapore, Singapore2021: 217-233http://link.springer.com/10.1007/978-981-15-6856-5_17Crossref Scopus (1) Google Scholar Risk factors for HAS include artery size mismatch, clamp injury, interrupted vasa vasorum during transplantation, extrinsic compression, graft rejection, ischemic injury during cold preservation, and prior transarterial chemoembolization.4Thornburg B. Katariya N. Riaz A. et al.Interventional radiology in the management of the liver transplant patient: thornburg et al.Liver Transpl. 2017 Oct; 23: 1328-1341Crossref PubMed Scopus (12) Google Scholar DUS is the first line of investigation in diagnosis of HAS. DUS findings in HAS include.a.Prestenotic hepatic artery shows resistivity index of >0.80. However, one should remember that resistivity index >0.80 can be seen in normal patients during immediate posttransplant period for first 3 days, which then gradually normalizes.b.At the site of narrowing, hepatic artery PSV measures >200 cm/s and shows turbulent flow. Hepatic artery PSV >400 cm/s can be seen in patients with >70% narrowing.c.Poststenotic hepatic artery shows reduced resistivity index (<0.50) and parvus-tardus waveform.1Delgado-Moraleda J.J. Ballester-Vallés C. Marti-Bonmati L. Role of imaging in the evaluation of vascular complications after liver transplantation.Insights Imag. 2019 Dec; 10: 78Crossref PubMed Scopus (16) Google Scholar,4Thornburg B. Katariya N. Riaz A. et al.Interventional radiology in the management of the liver transplant patient: thornburg et al.Liver Transpl. 2017 Oct; 23: 1328-1341Crossref PubMed Scopus (12) Google Scholar,6Gupta A. Narkhede A. Yadav A.K. Vascular complications after hepatic transplantation: role of interventional radiology in management.in: Mukund A. Basics of Hepatobiliary Interventions [Internet]. Springer Singapore, Singapore2021: 217-233http://link.springer.com/10.1007/978-981-15-6856-5_17Crossref Scopus (1) Google Scholar,17Kimura Y. Tapia Sosa R. Soto-Trujillo D. Kimura Sandoval Y. Casian C. Liver transplant complications radiologist can’t miss.Cureus. 2020 Jun 5; 12e8465https://doi.org/10.7759/cureus.8465Crossref Google Scholar HAS suspected on DUS is confirmed with CT angiography (Figure 1), which is the technique of choice. CT angiography allows better quantification of stenosis and also allows evaluation of hepatic artery when DUS is not possible due to improper window.1Delgado-Moraleda J.J. Ballester-Vallés C. Marti-Bonmati L. Role of imaging in the evaluation of vascular complications after liver transplantation.Insights Imag. 2019 Dec; 10: 78Crossref PubMed Scopus (16) Google Scholar Early HAS can be treated with surgical revision or endovascular management; however, endovascular management carries some risk of hepatic artery injury and rupture in early postoperative period.13Naidu S.G. Alzubaidi S.J. Patel I.J. et al.Interventional radiology management of adult liver transplant complications.Radiographics. 2022 Oct; 42: 1705-1723Crossref PubMed Scopus (3) Google Scholar Endovascular management is the first line of management for late onset HAS. Endovascular management options include angioplasty (Figure 1) with or without stenting and primary stenting alone. Both techniques are equally efficacious, with similar complication rates.6Gupta A. Narkhede A. Yadav A.K. Vascular complications after hepatic transplantation: role of interventional radiology in management.in: Mukund A. Basics of Hepatobiliary Interventions [Internet]. Springer Singapore, Singapore2021: 217-233http://link.springer.com/10.1007/978-981-15-6856-5_17Crossref Scopus (1) Google Scholar,17Kimura Y. Tapia Sosa R. Soto-Trujillo D. Kimura Sandoval Y. Casian C. Liver transplant complications radiologist can’t miss.Cureus. 2020 Jun 5; 12e8465https://doi.org/10.7759/cureus.8465Crossref Google Scholar A 2012 meta-analysis by Rostambeigi et al. showed that both angioplasty and stent placement were equally efficacious, with comparable patency rate.18Rostambeigi N. Hunter D. Duval S. Chinnakotla S. Golzarian J. Stent placement versus angioplasty for hepatic artery stenosis after liver transplant: a meta-analysis of case series.Eur Radiol. 2013 May; 23: 1323-1334Crossref PubMed Scopus (43) Google Scholar A more recent comparative study by Magand et al. showed higher 1 year patency rate with stent (93.8%) than with angioplasty alone (73.5%).19Magand N. Coronado J.L. Drevon H. et al.Primary angioplasty or stenting for hepatic artery stenosis treatment after liver transplantation.Clin Transplant. 2019 Dec; 33e13729Crossref PubMed Scopus (12) Google Scholar PTA alone for significant HAS carries risk of dissection and hepatic artery rupture in 7% of patients. Hepatic artery rupture or extravasation can be managed with covered stent placement.20Boyvat F. Aytekin C. Harman A. Sevmis S. Karakayali H. Haberal M. Endovascular stent placement in patients with hepatic artery stenoses or thromboses after liver transplant.Transplant Proc. 2008 Jan; 40: 22-26Crossref PubMed Scopus (38) Google Scholar Use of coronary stent for hepatic artery stenosis is considered as an off-label indication. Following stenting, 75 mg clopidogrel is administered daily for 6 months and 81 mg aspirin daily, indefinitely.13Naidu S.G. Alzubaidi S.J. Patel I.J. et al.Interventional radiology management of adult liver transplant complications.Radiographics. 2022 Oct; 42: 1705-1723Crossref PubMed Scopus (3) Google Scholar Surgical revascularization is considered for patients where endovascular treatment is unsuccessful. Retransplantation is treatment of choice, however, is limited by scarcity of liver graft and is reserved for patients where revascularization procedures fail.6Gupta A. Narkhede A. Yadav A.K. Vascular complications after hepatic transplantation: role of interventional radiology in management.in: Mukund A. Basics of Hepatobiliary Interventions [Internet]. Springer Singapore, Singapore2021: 217-233http://link.springer.com/10.1007/978-981-15-6856-5_17Crossref Scopus (1) Google Scholar3. Hepatic artery pseudoaneurysm (HAP) Hepatic artery pseudoaneurysm is a contained leak from the hepatic artery, which commonly occurs secondary to iatrogenic injury d" @default.
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• W4362475039 title "Imaging and Intervention in the Management of Vascular Complications Following Liver Transplantation" @default.
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