Safety and efficacy of an integrated endovascular treatment strategy for early hepatic artery occlusion after liver transplantation

作     者：Heng-Kai Zhu Li Zhuang Cheng-Ze Chen Zhao-Dan Ye Zhuo-Yi Wang Wu Zhang Guo-Hong Cao Shu-Sen Zheng Heng-Kai Zhu;Li Zhuang;Cheng-Ze Chen;Zhao-Dan Ye;Zhuo-Yi Wang;Wu Zhang;Guo-Hong Cao;Shu-Sen Zheng

作者机构：Division of Hepatobiliary and Pancreatic SurgeryDepartment of Surgerythe First Affiliated HospitalZhejiang University School of Medicine79 Qingchun RoadHangzhou 310003China NHC Key Laboratory of Combined Multi-organ TransplantationHangzhou 310003China Key Laboratory of the Diagnosis and Treatment of Organ TransplantationResearch Unit of Collaborative Diagnosis and Treatment for Hepatobiliary and Pancreatic CancerCAMSHangzhou 310003China Key Laboratory of Organ TransplantationZhejiang Provincial Research Center for Diagnosis and Treatment of Hepatobiliary DiseasesHangzhou 310003China Department of Hepatobiliary and Pancreatic SurgeryShulan(Hangzhou)HospitalZhejiang Shuren University School of MedicineHangzhou 310022China Department of Intensive Care UnitShulan(Hangzhou)HospitalZhejiang Shuren University School of MedicineHangzhou 310022China Department of RadiologyShulan(Hangzhou)HospitalZhejiang Shuren University School of MedicineHangzhou 310022China 

出 版 物：《Hepatobiliary & Pancreatic Diseases International》 (国际肝胆胰疾病杂志（英文版）)

年 卷 期：2020年第19卷第6期

页      面：524-531页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

基　　金：the National Major Science and Technology Projects of China(2017ZX10203201 and 2018ZX10301201) Project of Medical and Health Technology Program in Zhejiang Province(2016KYA073) 

主　　题：Liver transplantation Hepatic artery occlusion Hepatic artery thrombosis Hepatic artery stenosis Endovascular treatment 

摘      要：Background:Hepatic artery occlusion(HAO)after liver transplantation(LT)is typically comprised of hepatic artery thrombosis(HAT)and stenosis(HAS),both of which are severe complications that coexist and *** study aimed to evaluate an integrated endovascular treatment(EVT)strategy for the resolution of early HAO and identify the risk factors associated with early HAO as well as the procedural challenge encountered in the treatment ***:Consecutive orthotopic LT recipients(n=366)who underwent transplantation between June 2017 and December 2018 were retrospectively *** was performed using an integrated strategy that involved thrombolytic therapy,shunt artery embolization plus vasodilator therapy,percutaneous transluminal angioplasty,and/or stent *** EVT was defined as the clinical resolution of HAO by one round of EVT with thrombolytic therapy and/or shunt artery embolization plus vasodilator ***,it was defined as complex ***:Twenty-six patients(median age 52 years)underwent EVT for early HAO that occurred within 30 days *** median interval from LT to EVT was 7(6–16)*** time(OR=1.027;95%CI:1.005–1.050;P=0.018)and the need for conduit(OR=3.558;95%CI:1.241–10.203,P=0.018)were independent predictors for early *** was diagnosed in eight patients,and four out of those presented with concomitant *** achieved 100%technical success and recanalization by performing simple EVT in 19 patients(3 HAT+/HAS-and 16 HAT-/HAS+)and by performing complex EVT in seven patients(1 HAT+/HAS-,4 HAT+/HAS+,and 2 HAT-/HAS+),without major *** primary assisted patency rates at 1,6,and 12 months were all 100%.The cumulative overall survival rates at 1,6,and 12 months were 88.5%,88.5%,and 80.8%,*** transfusion600 mL(94.74%vs.42.86%,P=0.010)and interrupted suture for hepatic artery anastomosis(78.95%vs.14.29%,P=0.005)were more prevalent in simple ***