Clinical outcomes from hepatic artery stenting in liver transplantation
Clinical outcomes from hepatic artery stenting in liver transplantation
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DOI：
10.1002/lt.20628
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发表时间：
2006-03-01
影响因子：
4.6
通讯作者：
Klintmalm, GB
中科院分区：
文献类型：
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作者：
Ueno, T;Jones, G;Klintmalm, GB
肝移植术后肝动脉狭窄可影响肝功能，导致肝动脉血栓形成。手术重建已成为治疗的首选方法。介入放射学技术可以应用，但长期疗效未见报道。本文的目的是评估目前的结果和并发症的肝动脉支架。1998年至2003年，26例成人患者因肝动脉狭窄接受支架植入术。9例患者既往接受过肝动脉狭窄的手术重建。17例患者新发肝动脉狭窄。3例患者再次移植。支架植入术后，患者在第1天、1个月和6个月进行多普勒超声随访。安排在6个月内进行血管造影。4例患者在2个月内死亡。其他22例患者平均随访31 ± 14个月（8-71个月）。22例患者中有1例在2年后死于肾功能衰竭。12例支架术后肝动脉恢复正常。8例患者（36%）出现缓解。其他并发症为动脉血栓形成（n = 1）和长段狭窄（n = 1）。2例患者（25%）再狭窄导致血栓形成。8例复发性狭窄患者中有6例成功进行了介入治疗：再狭窄（n = 5）和球囊扩张（n = 3）。然而，3例患者（38%）再狭窄。Kaplan-Meier无并发症生存率为54%。总之，肝动脉支架植入术是治疗肝动脉狭窄的一种可行方法，其结果合理。支架植入术是手术翻修后的有效辅助治疗。
Hepatic artery stenosis after liver transplantation may affect liver function and result in hepatic artery thrombosis. Surgical reconstruction has been the first choice for treatment. Interventional radiologic technique can be used, but there is no report on long-term outcome. The aim of this paper is to assess current outcome and complications of hepatic artery stenting. Twenty-six adult patients were stented for hepatic artery stenosis between 1998 and 2003. Nine patients had previous surgical reconstruction for hepatic artery stenosis. Seventeen patients suffered newly developed hepatic artery stenosis. Three patients were retransplanted. After stenting, the patients were followed by Doppler ultrasound at day 1, 1 month, and 6 months. Angiography was scheduled in 6 months. Four patients died within 2 months. The other 22 patients were followed for mean 31 +/- 14 months (8-71 months). One of 22 patients died from renal failure 2 years later. Twelve patients' hepatic arteries looked normal after stenting. Restenosis was seen in 8 patients (36%). Other complications were artery thrombosis (n = 1) and long segment stricture (n = 1). In 2 patients (25%) restenosis resulted in thrombosis. Six of the 8 patients who developed recurrent stenosis were successfully treated interventionally: restent (n = 5) and balloon dilation (n = 3). However, 3 patients (38%) restenosed. Kaplan-Meier complication-free survival was 54% at 1 year after stenting. In conclusion, hepatic artery stenting is a viable treatment for hepatic artery stenosis with reasonable results. Stenting is useful as adjuvant treatment after surgical revision.