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Revista do Colégio Brasileiro de Cirurgiões

Print version ISSN 0100-6991

Rev. Col. Bras. Cir. vol.25 no.3 Rio de Janeiro June 1998

http://dx.doi.org/10.1590/S0100-69911998000300013 

RELATOS DE CASOS

 

Estenose arterial pós-transplante hepático: tratamento com angioplastia transluminal percutânea

 

Arterial stenosis after liver transplantation: treatment by transluminal percutaneous angioplasty

 

 

Néstor Hugo KisilevzkyI; José Maria Modenesi FreitasI; Fernando Luis PandulloII; Tércio GenziniIII; Marcelo Perosa de MirandaIII; Wilson Modesto Pollara, TCBC-SPIV

IMédico do Serviço Radiologia lntervencionista
IIMédico Hepatologista da equipe de Transplante Hepático
IIIMédico Cirurgião da equipe de Transplante Hepático
IVDiretor Clínico

Endereço para correspondência

 

 


ABSTRACT

Vascular complications after liver transplantation include oclusion or stenosis at the sites of anastomosis in the hepatic artery, portal vein, and vena cava. Balloon angioplasty of these stenosis carries little risk and is a useful procedure for the treatment of these problems. The purpose of this paper was to assess whether percutaneous transluminal angioplasty can help to prolong allograft survival and impruve allograft function in patient with hepatic artery stenosis after liver transplantation. We report a 43-year-old mate with stenosis of hepatic artery anastomosis after liver transplantation. An abrupt elevation of liver enzymes and serum bilirrubin levels was noted on the fifth postoperative month. The patient underwent percutaneous liver biopsy, which revealed important ductal depletion due to hypoperfusion, even though Doppler ultrasound examination demonstrated arterial flow. An angiogram confirmed severe stenosis of the arterial anastomosis with poor intraparenchymal arterial perfusion pattern. In an attempt to preserve the graft, a percutaneous transluminal angioplasty was performed using microballoons mounted on a hydrophylic micro guidewire. Intervention proceeded without complications. Liver enzimes and bilirrubin levels decreased within twenty-four hours of angioplasty. Normal levels were achieved after one week. Seven month after angioplasty, the patient is in a optimal clinical condition with no signs of graft impairment. We conclude that percutaneous transluminal angioplasty of hepatic artery stenosis after liver transplantation is relatively safe and may help decrease allograft loss.

Key words: Arterial stenosis; Liver transplantation; Angioplasty.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

REFERÊNCIAS

1. Valente JF, Alonso MH, Weber FL, et al. Late hepatic artery trombosis in liver allograft recipients is associated with intrahepatic biliary necrosis. Transplantation 1996; 61: 61-65.         [ Links ]

2. Anthuber M, Jauch KW, Zulke C, et al. Arterial complications after liver transplantation. Zentralbl Chir 1995; 120: 439-444.         [ Links ]

3. Abbasog1u O, Levy MF, Vodapally MS, et al. Hepatic artery stenosis after liver transplantation - incidence, presentation, treatment, and long term outcome. Transplantation  1997; 63:250-255.         [ Links ]

4. Orons PD, Zajko AB, Bron KM, et al. Hepatic artery angioplasty after liver transplantation: experience in 21 allografts. J Vasc Interv Radiol  1995; 6: 523-529.         [ Links ]

5. Dravid VS, Shapiro MJ, Needleman L, et al. Arterial abnormalities following liver transplantation: arteriographic findings and correlation with Doppler sonographic findings. AJR 1994; 163: 585- 589.         [ Links ]

 

 

Endereço para correspondência:
Dr. Néstor Hugo Kisilevzky
Rua Guararapes, 682
05077-051 - São Paulo - SP

Recebido em 29/9/97
Aceito para publicação em 4/12/97

 

 

Trabalho realizado no Hospital São Camilo - São Paulo - SP.

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