Background

Hepatic artery occlusion (HAO) after liver transplantation (LT) is typically comprised of hepatic artery thrombosis (HAT) and stenosis (HAS), both of which are severe complications that coexist and interdependent. This study aimed to evaluate an integrated endovascular treatment (EVT) strategy for the resolution of early HAO and identify the risk factors associated with early HAO as well as the procedural challenge encountered in the treatment strategy.

Methods

Consecutive orthotopic LT recipients (n = 366) who underwent transplantation between June 2017 and December 2018 were retrospectively investigated. EVT was performed using an integrated strategy that involved thrombolytic therapy, shunt artery embolization plus vasodilator therapy, percutaneous transluminal angioplasty, and/or stent placement. Simple EVT was defined as the clinical resolution of HAO by one round of EVT with thrombolytic therapy and/or shunt artery embolization plus vasodilator therapy. Otherwise, it was defined as complex EVT.

Results

Twenty-six patients (median age 52 years) underwent EVT for early HAO that occurred within 30 days post-LT. The median interval from LT to EVT was 7 (6–16) days. Revascularization time (OR = 1.027; 95% CI: 1.005–1.050; P = 0.018) and the need for conduit (OR = 3.558; 95% CI: 1.241–10.203, P = 0.018) were independent predictors for early HAO. HAT was diagnosed in eight patients, and four out of those presented with concomitant HAS. We achieved 100% technical success and recanalization by performing simple EVT in 19 patients (3 HAT+/HAS- and 16 HAT-/HAS+) and by performing complex EVT in seven patients (1 HAT+/HAS-, 4 HAT+/HAS+, and 2 HAT-/HAS+), without major complications. The primary assisted patency rates at 1, 6, and 12 months were all 100%. The cumulative overall survival rates at 1, 6, and 12 months were 88.5%, 88.5%, and 80.8%, respectively. Autologous transfusion < 600 mL (94.74% vs. 42.86%, P = 0.010) and interrupted suture for hepatic artery anastomosis (78.95% vs. 14.29%, P = 0.005) were more prevalent in simple EVT.

Conclusions

The integrated EVT strategy was a feasible approach providing effective resolution with excellent safety for early HAO after LT. Appropriate autologous transfusion and interrupted suture technique helped simplify EVT.

中文翻译：

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肝移植术后早期肝动脉闭塞的综合血管内治疗策略的安全性和有效性

背景

肝移植 (LT) 后的肝动脉闭塞 (HAO) 通常由肝动脉血栓形成 (HAT) 和狭窄 (HAS) 组成，这两者都是并存且相互依存的严重并发症。本研究旨在评估用于解决早期 HAO 的综合血管内治疗 (EVT) 策略，并确定与早期 HAO 相关的危险因素以及治疗策略中遇到的程序挑战。

方法

 对 2017 年 6 月至 2018 年 12 月期间接受移植的连续原位 LT 接受者（n = 366）进行了回顾性调查。EVT 采用综合策略进行，包括溶栓治疗、分流动脉栓塞加血管扩张剂治疗、经皮腔内血管成形术和/或支架置入术。简单 EVT 定义为通过一轮 EVT 溶栓治疗和/或分流动脉栓塞加血管扩张剂治疗使 HAO 临床消退。否则，它被定义为复杂的 EVT。

结果

26 名患者（中位年龄 52 岁）因 LT 后 30 天内发生的早期 HAO 接受了 EVT。从 LT 到 EVT 的中位间隔时间为 7 (6–16) 天。血运重建时间（OR = 1.027；95% CI：1.005–1.050；P  = 0.018）和导管需求（OR = 3.558；95% CI：1.241–10.203，P = 0.018) 是早期 HAO 的独立预测因子。8 名患者被诊断为 HAT，其中 4 名伴有 HAS。我们通过对 19 名患者（3 名 HAT+/HAS- 和 16 名 HAT-/HAS+）进行简单 EVT 以及对 7 名患者（1 名 HAT+/HAS-、4 名 HAT+/HAS+ 和 2 名）进行复杂 EVT，实现了 100% 的技术成功和再通HAT-/HAS+)，无重大并发症。1 个月、6 个月和 12 个月的初级辅助通畅率均为 100%。1、6和12个月的累积总生存率分别为88.5%、88.5%和80.8%。自体输血 < 600 mL（94.74% 对 42.86%，P  = 0.010）和间断缝合肝动脉吻合术（78.95% 对 14.29%，P  = 0.005）在单纯 EVT 中更为普遍。

结论

综合 EVT 策略是一种可行的方法，可为 LT 后的早期 HAO 提供有效的解决方案和出色的安全性。适当的自体输血和间断缝合技术有助于简化 EVT。