Ultrasound findings after endovascular stent deployment in transplant liver hepatic artery stenosis

Lall, Neil U., Bluth, Edward I. and Sternbergh, W. C. (2014) Ultrasound findings after endovascular stent deployment in transplant liver hepatic artery stenosis. American Journal of Roentgenology, 202 3: W234-W240. doi:10.2214/AJR.12.9612


Author Lall, Neil U.
Bluth, Edward I.
Sternbergh, W. C.
Title Ultrasound findings after endovascular stent deployment in transplant liver hepatic artery stenosis
Journal name American Journal of Roentgenology   Check publisher's open access policy
ISSN 0361-803X
1546-3141
Publication date 2014-03-01
Year available 2014
Sub-type Article (original research)
DOI 10.2214/AJR.12.9612
Volume 202
Issue 3
Start page W234
End page W240
Total pages 7
Place of publication Leesburg, VA, United States
Publisher American Roentgen Ray Society
Collection year 2015
Language eng
Formatted abstract
OBJECTIVE. Endovascular stenting is a safe, effective treatment of hepatic artery stenosis after liver transplant, but no detailed evaluation has been completed of changes in ultrasound monitoring parameters after stenting. This study aims to improve poststenting surveillance by delineating the expected postoperative findings.

MATERIALS AND METHODS. Thirty-one stent procedures were performed at our institution for hepatic artery stenosis after liver transplant between October 2010 and October 2012. Of these, 28 (90%) were technically successful, of which 23 met the minimum follow-up time (76 days, defined by the earliest diagnosed restenosis). These patients were followed with serial ultrasound, per the following schedule: within 1 week of stenting, 3 months after stenting, 6 months after stenting, and every 6 months thereafter; additional, unscheduled examinations were frequently performed when indicated on the basis of deterioration of clinical and laboratory status. Follow-up examinations (mean, 268 days total follow-up) were compared with prestenting examinations to evaluate changes in peak systolic velocity (PSV), resistive index (RI), and tardus-parvus waveforms. Data were analyzed to determine a normal range for postprocedure values and time course of change in values.

RESULTS. Of the 23 patients, six experienced restenosis. In all patients, mean PSV decreased by 124 cm/s, and mean RI increased by 0.13 within 48 hours after stenting. PSV differed between patency and restenosis groups only at more than 90 days after stenting (mean PSV, 234 and 400 cm/s, respectively), with PSV above 300 cm/s serving as a high-sensitivity threshold for the determination of restenosis. Prestenting RI of below 0.40 had a strong correlation with restenosis. Poststenting RI differed between patency and restenosis groups only at more than 48 hours after stenting, with RI of below 0.55 having a strong correlation with restenosis. Tardus-parvus waveform resolution was often delayed well beyond 48 hours after stenting, and time to tardus-parvus waveform resolution had no correlation with patency or restenosis.

CONCLUSION. Ultrasound is convenient and useful to follow stents in hepatic artery stenosis after liver transplant. Prestenting hemodynamics can have value in predicting restenosis. Diagnosis of restenosis can be made with RI and PSV, whereas resolution time of tardus-parvus waveform is of less concern. These parameters can guide which patients require closer monitoring and aggressive treatment.





Keyword Endovascular stenting
Hepatic artery stenosis
Liver transplant
Sonography
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
 
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