Abstract:

This case describes successful combined treatment of patient with large hepatocellular carcinoma BCLC «B», occupying the entire right lobe of the liver, extending to the fourth segment and occupying the right lateral flank till small pelvis. As the first stage, selective tumor chemoembolization, mechanical chemoembolization of right portal vein branches with the aim of vicarious hypertrophy of remaining liver segments were performed. One and half months after performed procedure, the volume of remnant parenchyma was 31% of the total volume. According to the test with indocyanine green, the plasma elimination rate (ICG-PDR) was 12,2%/min, and the residual concentration at 15 minutes was 16%. Subsequently, was performed surgical intervention: Starzl laparotomy, revision of abdominal organs, cholecystectomy, right-sided hemihepatectomy + SI, drainage of the common bile duct according to Vishnevsky, lymphadenectomy of the hepatoduodenal ligament, drainage of abdominal cavity. Postoperative period was complicated by formation of an external biliary fistula and hepatic failure, regarded as class «B» according to criteria of the International Research Group for Liver Surgery (ISGLS), which required medical correction of patient's condition without use of extracorporeal detoxification methods. Later, patient was diagnosed with foci of recurrence of disease in the remaining parenchyma of the liver, for which endovascular treatment was carried out. Currently, patient is alive (6 years after surgery) and is receiving systemic treatment for the extrahepatic spread of the underlying disease.

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Abstract:

Introduction: arterial complications after orthotopic liver transplantation are common cause of graft loss (10-40%).

Aim: was to estimate efficiency of endovascular interventions in correction of revealed arterial complications in patients after OLT.

Material and methods: for the period of 2015-2020, arterial complications after 104 OLT were revealed in 24(23%) pts and were divided into 4 groups: «steal»-syndrome (n=8), hepatic artery thrombosis (n=7), combination of hepatic artery stenosis and «steal» syndrome (n=6), hepatic artery stenosis (n=3). Endovascular interventios such as splenic artery embolization, direct thrombolysis, stenting and balloon plastic were performed for correction of these complications.

Results: using of endovascular treatment, we successfully identified and correct complications with saving of the graft in 14 pts (58%), 10 pts died because of biliary necrosis, sepsis and graft loss.

Conclusion: early detection and elimination of emerging arterial complications after OLT play a keyrole in saving of organs and patients’ life.

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Abstract:

A 57-year-old woman was on the waiting list of Orthotopic Liver Transplantation (OLT) due to cirrhosis of viral etiology MSCT with contrast enhancement showed two aneurysms of the splenic artery, stenosis of the celiac trunk with aneurysm of the pancreaticoduodenal artery Taking into account asymptomatic course, we decided to eradicate vascular changes during the forthcoming OLT OLT performed 6 month later, was technically difficult and complicated by massive blood loss and episodes of unstable hemodynamics, so surgical correction of aneurysms was not performed because of high risk. The patient was well and asymptomatic for 2 years after the OLT, but then she developed abdominal pain. MSCT showed progression of vascular changes. Successful endovascular treatment included celiac trunk stenting and embolization of aneurysms. 

References

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Abstract:

Aim: was to estimate possibilities of optical coherence tomography (OCT) in diagnostics of pathology of bile ducts in combination with percutaneous transhepatic biliary drainage (PTBD).

Materials and methods: examined 5 patients with obstructive jaundice, suspected cancerous etiology OCT was performed during or 5-14 days after PTBD. For morphological confirmation of results we performed forceps intraductal biopsies.

Results: tomographic evidences of the malignant stricture were revealed in 4 (80%) patients anc in 1 patient benign stricture was determined. Diagnoses were confirmed histologically (80%) and clinically (20%). Sensitivity of the OCT was 100%.

Conclusion: percutaneous transhepatic OCT appeared to be a perspective method for differential diagnostics of biliary strictures. 

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