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Objective To study the use of contrast-enhanced ultrasound in diagnosing splenic arterial steal syndrome (SASS) after liver transplantation,and to compare the curative effect,safety and follow-up results of the different embolization methods in the treatment of SASS after liver transplantation.Methods From January 2005 to December 2017,41 patients after liver transplantation in our hospital developed splenic artery steal syndrome and were treated with splenic arterial embolization.All these patients underwent ultrasound,and in 19 patients contrast-enhanced ultrasonography was also done to detect the presence of splenic artery steal.The findings were confirmed by angiography.These patients then underwent splenic arterial embolization.In 32 patients coil embolization was done (group A) and in 9 patients embolization was assisted with Amplatzer occluders (group B).Results In all the 41 patients with SASS,angiography after splenic artery embolization showed the second and third order arterial branches in the liver increased in number and in diameter with good blood flow compared with those before treatment.The postoperative blood flow and pattern on ultrasound returned to normal.In group A,12 patients (12/32,37.5％) developed splenic infarction,including 11 patients with partial splenic infarction,and 1 patient developed a splenic abscess after complete splenic infarction.In group B,two patients developed partial splenic infarction (2/9,22.2％).All the patients with splenic infarct had no clinical symptoms.No treatment was required except for the patient who developed splenic abscess after complete splenic infarction.The patient recovered well after treatment with antibiotics and splenic abscess drainage.There was no other complications.Conclusions Contrast-enhanced ultrasound provided early diagnosis of splenic artery steal after liver transplantation.Interventional splenic artery embolization was safe and effective to treat splenic arterial steal syndrome after liver transplantation.Coil embolization assisted with Amplatzer occluders was better than the traditional coil embolization with more accurate embolization site and fewer complications.
ABSTRACT
Objective To evaluate the value of ultrasonography in the diagnosis of splenic artery steal syndrome (SASS ) after liver transplantation. Methods Routine ultrasonography and contrast enhanced ultrasound (CEUS)were performed in 10 cases with SASS (SASS group)and 8 cases of control patients with normal liver function after liver transplantation. The ultrasonographic findings of SASS were summed up. The diagnostic efficacy of CEUS was compared with that of digital subtraction angiography (DSA). Results In the SASS group,2D ultrasonography showed that the hepatic parenchyma was normal or there were some tiny necrosis foci in it,and color Doppler flow imaging (CDFI)showed that the blood flow signal of the hepatic artery was sparse or punctiform. CEUS showed the delayed and weak contrast-enhanced signals in hepatic artery after transplantation. The internal diameter of the splenic artery increased while that of the hepatic artery decreased. There was no significant difference between CEUS and DSA. Conclusions The routine ultrasonography and CEUS have a high value on the detection of suspected abnormal vascular system of transplant liver after liver transplantation as the noninvasive diagnostic tools.
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Objective To study the diagnosis,prophylaxis and treatment of splenic artery steal syndrome (SASS),and to evaluate their clinical outcomes in recipients who underwent orthotopic liver transplantation (OLT).Methods 1 385 consecutive patients who suffered from liver cirrhosis and had undergone OLT in our hospital between Jan,2004 and Dec,2013 were studied.We hypothesized that patients were at risk of SASS when the calibre of the splenic artery (SA) was 1.5 times larger than the common hepatic artery (CHA) together with splenomegaly (318 patients,23.0％).Further surveillance with Doppler ultrasound (DUS) was carried out immediately at CHA reperfusion during operation.When a sluggish peak systolic velocity (PSV) ＜ 30 cm/s or no flow was detected in a patent hepatic artery,prophylactic SA banding (SAB) was considered.127 patients (39.9％) who fulfilled these criteria were recruited to the intervention group to undergo SAB.Eventually,patients who developed SASS were treated with coil-embolization of the SA (SAE),re-anastomosis of the HA to aorta (HTA),ligation of SA (SAL) or splenectomy (SPT),or retransplantation.Results SAB resulted in immediately increase in the mean PSV of the HA from 19.3 ±5.5 cm/s to 45.9 ± 9.1 cm/s (P ＜ 0.05),and resistance index (RI) of the HA rehabilitated to reasonable levels (0.5 ～0.8),without any HA or biliary related complication in all the 127 patients.17 patients in the control group were identified to have SASS (8.9％).5 of these 17 patients required emergency treatment by coil-embolization.Of the remaining 12 patients,11 who developed hepatic artery thrombosis secondary to SASS required to undergo embolectomy or thrombolysis followed by HTA (4 patients),SAL (3 patients),SPT (5 patients).Three of these patients finally required re-OLT.All these patients obtained acceptable results by these salvage strategies,except 2 out of the 12 patients who died from liver failure.Conclusions SASS is an important but it is often and under-diagnosed cause of graft ischemia after OLT.Prophylactic SAB should be introduced to patients at risk of developing SASS in order to obtain satisfactory results.Coil-embolization of SA shortly after diagnosis is an effective salvage intervention to prevent further progression to develop devastating consequences.
ABSTRACT
Objective To investigate the utilization of contrast-enhanced ultrasound (CEUS) for the detection of splenic artery steal syndrome (SASS) after orthotropic liver transplantation (OLT).Methods Color Doppler flow imaging (CDFI) were performed at various time points post-operatively.CEUS and celiac angiography were conducted in patients suspected of SASS.Results 9 patients were suspected of SASS by slim or undetectable hepatic arterial Doppler blood signals by CDFI at various time points postoperatively.CEUS in 9 patients showed a delayed and weak contrast-enhanced blood signal in the hepatic artery associated with a rapid and intense enhancement of portal venous blood.No narrowing of a hyperintense signal was observed in the hepatic artery by CEUS.The 9 diagnoses of SASS were proven by celiac angiography.Conclusions SASS is identified as a sluggish and weak hyperintense blood signal in the hepatic artery without the narrowing and interruption of hypeintense signal in CEUS.CEUS is an effective imaging modality for detection of SASS following OLT.