Boyvat F, Aytekin C, Karakayali H, Ozyer U, Sevmis S, Emiroğlu R, Haberal M.
放射科，巴基肯特大学，安卡拉，土耳其。

原位肝移植术后肺动脉狭窄（HAS）和血栓形成（HAT）依然是导致移植肝失功能的重要原因。原位肝移植术后HAT的发病率接近5%至19%，在小儿肝移植中更为常见。过去，移植肝失功能的首选治疗方案是再次移植，但是近期又有了新的治疗方法，即建议使用介入放射技术，例如血栓溶解、经皮血管腔内血管成形术、肝动脉支架等，但对于小儿肝移植患者，术后早期在形成血栓的肝动脉内放置支架尚缺乏数据支持。2000年3月至2005年3月期间，7名小儿肝移植患者接受了经皮血管腔内支架置入术。通过多普勒超声已初步确诊所有患者均为HAT或 HAS，然后血管造影术证实了以上诊断。我们对4例肝动脉狭窄和3例肝动脉闭塞患者进行了介入治疗，所有患者均放置了支架。应用盖冠状动脉支架进行肝动脉经皮血管腔内血管成形术时，术后第1、5、17天出现了三处破裂。其中一名患者由于引导管进行了肝动脉端解剖，并在解剖部位放置了第二个支架；其他两个肝动脉支架均正常。介入治疗3个月后此患者其中一个支架闭塞，但无临床问题。术后对患者进行了9个月至40个月不等的随访。总之，肝移植术后早期和晚期放置支架在技术上来说都是可行的。

PMID: 17175359 [PubMed - indexed for MEDLINE]

Transplant Proc. 2006 Dec; 38(10):3656-60.

Boyvat F, Aytekin C, Karakayali H, Ozyer U, Sevmis S, Emiro lu R, Haberal M.Department of Radiology, Baskent University, Ankara, Turkey.

　　　Hepatic artery stenosis (HAS) and thrombosis (HAT) after orthotopic liver transplantation remain significant causes of graft loss. Postoperative HAT follows approximately 5% to 19% of orthotopic liver transplantation. It is seen more frequently in pediatric patients. In the past, repeat transplantation was considered the first choice for therapy. Recently, interventional radiological techniques, such as thrombolysis, percutaneous transluminal angioplasty, or stent placement in the hepatic artery, have been suggested, but little data exist related to stent placement in the thrombosed hepatic artery during the early postoperative period in pediatric patients. Between March 2000 and March 2005, percutaneous endoluminal stent placement was performed in seven pediatric liver transplant patients. HAT or HAS initially diagnosed in all cases by Doppler ultrasound then confirmed angiographically. We intervened in four cases of hepatic artery stenosis and three cases of hepatic artery occlusion. Stents were placed in all patients. Three ruptures were seen during percutaneous transluminal angioplasty of the hepatic artery using a covered coronary stents on the first, fifth day, or 17th postoperative day. In one patient, dissection of the origin of the common hepatic artery developed owing to a guiding sheath, and a second stent was placed to cover the dissected segment. The other two hepatic artery stents remained patent. In one stent became occluded at 3 months after the intervention with no clinical problems. Follow-up ranged from 9 to 40 months. In conclusion, early and late postoperative stent placement in the graft hepatic artery was technically feasible.
PMID: 17175359 [PubMed - indexed for MEDLINE]

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