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.

References

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Abstract:

Intraoperative vascular injury is infrequent complication (0.02-0.06%) during surgical operations on lumbar discs. We report a case of a 44-year-old man with oedema and varicose veins of the right lower limb. Despite an 4-year history of oedema and varicose veins, he appeared to be asymptomatic and could recollect no traumatic injury or surgery that might have caused it. Near the vertebral column, we found a small scar, the result of spinal disk surgery six years before. CT scan showed pseudoaneurysm of the right iliac artery with a 54 mm diameter. Thereafter, we located the suspected arteriovenous fistula by selective angiography of the aorta and its branches: a communication of the right iliac artery with the right iliac vein had resulted in a large shunt. This lesion was repaired by transluminal placement of stent-grafts Aorfix (Lombard Medical, UK). We had to use three stent-grafts due to the large difference in diameter between the common and external right iliac arteries. Hemodynamic improvement was immediate, and the postoperative course was uneventful. At the present time, almost six months postoperatively, the patient is asymptomatic. Sealing of pseudoaneurysm and arteriovenous fistula as a complication of lumbar-disc surgery with a stent graft is simple and is suggested as an excellent alternative to open surgery for iatrogenic vessel injuries. 

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