Asymptomatic hepatic artery dissection early after living-donor liver transplantation with simultaneous splenectomy: two case reports

Multi-modal imaging for the diagnosis of spontaneous visceral artery dissection: A case report

BACKGROUND

Spontaneous visceral artery dissection (SVAD) is a rare condition that affects the visceral arteries, such as the celiac, superior mesenteric, and inferior mesenteric arteries, without involving the aorta. Organ ischemia or hemorrhage from vessel rupture can occur in SVAD; therefore, prompt detection and management is essential. Contrast-enhanced computed tomography (CECT) has been used to diagnose most of the previous cases, but few studies have explored the potential of contrast-enhanced ultrasound (CEUS) for early detection of this disease.

CASE SUMMARY

A 53-year-old male presented with complaints of poor appetite and abnormal liver function for the past 6 months. He had previously undergone transabdominal splenectomy, esophagogastric devascularization, and cholecystectomy for gallstones and severe portal hypertension. Liver ultrasound was performed in our department to assess liver status. An abnormal hepatic artery spectrum was observed, and dissection involving both the celiac artery and the common hepatic artery was observed. A CEUS was then performed and clearly showed the entry site of the intimal tear and the false lumen, and dissection was subsequently confirmed by CECT. The patient was asymptomatic; therefore, treatment to control the blood pressure was provided, and follow-up was recommended. After 6 months of follow-up, the celiac artery was found to be dilated with an adherent thrombus visible in the wall, and the common hepatic artery was occluded with the presence of collateralization. Despite these findings, no significant changes in liver function were observed.

CONCLUSION

Multi-modal imaging is effective in diagnosing SVAD, and conservative treatment is a choice for asymptomatic patients.

Prognostic value of ultrasound in early arterial complications post liver transplant

Liver transplantation is the primary therapeutic intervention for end-stage liver disease. However, vascular complications, particularly those involving the hepatic artery, pose significant risks to patients. The clinical manifestations associated with early arterial complications following liver transplantation are often nonspecific. Without timely intervention, these complications can result in graft failure or patient mortality. Therefore, early diagnosis and the formulation of an optimal treatment plan are imperative. Ultrasound examination remains the predominant imaging modality for detecting complications post liver transplantation. This article comprehensively reviews common causes and clinical presentations of early hepatic artery complications in the post-transplantation period and delineates abnormal sonographic findings for accurate diagnosis of these conditions. Overall, ultrasound offers the advantages of convenience, safety, effectiveness, and non-invasiveness. It enables real-time, dynamic, and precise evaluation, making it the preferred diagnostic method for post-liver transplantation assessments.

A novel microsurgical reconstruction technique in a living-related liver donor hepatic artery dissection using the native hepatic artery

In living donor liver transplantation, hepatic artery intimal dissection is a rare but devastating complication often resulting in the inability to utilize the graft. We detail the salvage of a dissected donor right hepatic artery utilizing the recipient hepatic artery. After removal of the right lobe, the donor artery was found to have an intimal dissection extending to multiple branches. The liver transplant surgeons requested their plastic microsurgeon colleague to assist with reconstruction. Ultimately, the native recipient hepatic artery was used as a branch graft as the caliber and branching pattern was appropriate. Back table microvascular reconstruction was performed using the explanted recipient hepatic artery branches as a graft to the four donor artery branches. Every anastomosis was assessed with intraoperative doppler; all were patent with acceptable flow characteristics. The patient did well post-operatively with post-operative ultrasounds demonstrating patency of the graft. Four months post-transplantation the patient developed two polymicrobial abscesses that were drained and resolved with normalization of liver function tests. This case highlights how collaboration with a microvascular surgeon enabled the salvage of a living donor graft when faced with a complex arterial dissection.