Case Report A Successful Case of Liver Transplantation in a Recipient’s Hepatic Artery Dissection and Splenic Arterial Steal Syndrome
by Feihong Zhang1-4#, Zhenggang Xu1-3#, Zhongming Tan1-3*, Ke Wang1-3*
1Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
2Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, Jiangsu, China.
3NHC Key Laboratory of Living Donor Liver Transplantation (Nanjing Medical University), Nanjing, Jiangsu, China.
4Department of Anorectal Surgery, Sir Run Run Hospital Nanjing Medical University, Nanjing, Jiangsu, China.
#Contributed equally to this work.
*Corresponding authors: Zhongming Tan, Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
Ke Wang, Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Received Date: 31 October 2023
Accepted Date: 03 November 2023
Published Date: 06 November 2023
Citation: Zhang F, Xu Z, Tan Z, Wang K (2023) A Successful Case of Liver Transplantation in a Recipient’s Hepatic Artery Dissection and Splenic Arterial Steal Syndrome. Ann Case Report 8: 1501. https://doi.org/10.29011/2574-7754.101501
Abstract
Common hepatic artery dissection (CHAD) during orthotopic liver transplantation is a rare but significant risk factor for thrombosis of the hepatic artery (HA), which can result in liver failure and death. Here, we report the successful management of a recipient CHAD and splenic arterial steal syndrome during orthotopic liver transplantation. A 50-year-old male with a 20-year history of post-hepatitis B cirrhosis underwent liver transplantation of a graft from a 61-year-old brain-death donor On October 14, 2019. Intraoperatively, a dissection was found in the recipient common hepatic artery-gastroduodenal artery (CHA-GDA) patch, with an external diameter of about 0.5 cm and constriction of the inner cavity. A novel strategy was employed that included first suturing the tunica intima and tunica externa of the CHA-GDA patch followed by anastomosis to the grafted CHA-sphenopalatine artery (SPA) patch. Angioplasty and stenting were performed immediately to ensure adequate hepatic infusion and prevent arterial anastomotic stenosis and thrombosis, while SPA coil embolization was performed to prevent splenic arterial steal syndrome. This study is in compliance with the Declaration of Helsinki and the Declaration of Istanbul. The recipient recovered uneventfully and was discharged on postoperative day 36. At 3 years after surgery, liver function was normal and the HA was unobstructed. For HA dissection, the initial use of artery revision and endovascular treatment is both safe and efficient.
Keywords: Hepatic Artery Dissection; Splenic Arterial Steal Syndrome; Liver Transplantation
Abbreviations: CHAD: Common Hepatic Artery Dissection; HA: Hepatic Artery; GDA: Gastroduodenal Artery; SPA: Sphenopalatine Artery; CT: Computed Tomography; DSA: Digital Subtraction Angiography; PSV: Peek Systolic Flow Velocity, EDV: End Diastolic Velocity; RI: Resistance Index; POD: Postoperative Day