Diagnosis and management of hepatic artery in-stent restenosis after liver transplantation by optical coherence tomography:A case report

• 作者: Adriano Mendes Caixeta Breno Boueri Affonso Camila Antunes Lima Conrado Dias Pacheco Annicchino Baptistella Felipe Nasser Francisco Leonardo Galastri Guilherme Moratti Gilberto Leonardo Guedes Moreira Valle Lucas Lembrança Pinheiro Marcela Juliano Silva Márcio Dias de Almeida Nelson Wolosker Priscila Mina Falsarella Rodrigo Gobbo Garcia
• 来源期刊: 世界肝病学杂志:英文版(电子版)
• 学科: 医学
• 关键词: Liver transplantation Hepatic artery restenosis TOMOGRAPHY Optical coherence Case report Endovascular procedures ANGIOGRAPHY
• 年，卷（期）: 2020,（7）
• 页码范围: 399-405
• 页数: 7页
• 分类号: R54

摘要

BACKGROUNDPercutaneous transluminal angioplasty and stenting represent an effectivetreatment for hepatic artery stenosis after liver transplantation. In the first yearafter stenting, approximately 22% of patients experience in-stent restenosis,increasing the risk of artery thrombosis and related complications, and 50%experience liver failure. Although angiography is an important tool for diagnosisand the planning of therapeutic interventions, it may raise doubts, especially insmall-diameter arteries, and it provides low resolution rates compared withnewer intravascular imaging methods, such as optical coherence tomography(OCT).CASE SUMMARYA 64-year-old male developed hepatic artery stenosis one year after orthotropicliver transplantation and was successfully treated with percutaneous transluminalangioplasty with stenting. Five months later, the Doppler ultrasound resultsindicated restenosis. Visceral arteriography confirmed hepatic artery tortuositybut was doubtful for significant in-stent restenosis (ISR) and intrahepatic flowreduction. To confirm ISR, identify the etiology and guide treatment, OCT wasperformed. OCT showed severe stenosis due to four mechanisms: Focal andpartial stent fracture, late stent malapposition, in-stent neointimal hyperplasia,and neoatherosclerosis.CONCLUSIONIntravascular diagnostic methods can be useful in evaluating cases in which initialangiography results are not sufficient to provide a proper diagnosis of significantstenosis, especially with regard to ISR. A wide range of diagnoses are provided byOCT, resulting in different treatment options. Interventional radiologists shouldconsider intravascular diagnostic methods as additional tools for evaluatingpatients when visceral angiography results are unclear.