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

Arterial stenosis after liver transplantation: treatment by transluminal percutaneous angioplasty

Arterial stenosis; Liver transplantation; Angioplasty

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 Kisilevzky^I; José Maria Modenesi Freitas^I; Fernando Luis Pandullo^II; Tércio Genzini^III; Marcelo Perosa de Miranda^III; Wilson Modesto Pollara, TCBC-SP^IV

^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.

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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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Endereço para correspondência:

Dr. Néstor Hugo Kisilevzky

Rua Guararapes, 682

05077-051 - São Paulo - SP

Datas de Publicação

• Publicação nesta coleção
  28 Jul 2010
• Data do Fascículo
  Jun 1998

Histórico

• Aceito
  04 Dez 1997
• Recebido
  29 Set 1997