The presence of hepatic arterial stenosis (HAS) in patients with biliary strictures (BS) following liver transplantation is common. The treatment of these biliary complications remains diffi cult. The aim of this study is to report 7 patients with BS associated with HAS treated by simultaneous artery and biliary surgical repair. Among 787 OLT performed from 1991 to 2005, 12 patients (1.5%) experienced BS associated with HAS. Retransplantation was indicated in 5 patients with intrahepatic biliary stenosis. In seven cases, with exclusive extrahepatic BS and HAS, simultaneous biliary and arterial repair were considered. Patients, aged from 31 to 60 years, underwent liver transplantation and experienced BS 42 days and HAS 66 days after transplantation. Simultaneous biliary and arterial repair was indicated in the presence of biliary duct to duct stenosis in 6 cases and after Roux-en-Y choledochojejunostomy in one case. All arterial stenosis were more than 50% of the arterial diameter. Six patients had had BS previously treated by plastic prothesis and two had had HAS previously treated by endovascular stent or pneumatic dilation. Arterial repair was the fi rst step of the procedure with a complete resection of the arterial stricture followed by a termino-terminal arterial anastomosis. No graft interposition was needed. In one case stenosis involved only the right hepatic artery while in the 6 other cases the stenosis was located at the site of the anastomosis. In all cases resistance index was > 0.5 on intra-operative doppler ultrasound after reconstruction. Biliary repair included in all cases a Roux-en-Y biliaryjejunostomy. There were no postoperative deaths and morbidity was observed in only one patient. No postoperative biliary fi stulas were observed and the mean hospital length of stay was 16 days. With a mean follow up of 67 months, all patients are alive without graft loss. Recurrent arterial stenosis was discovered in one patient and although successfully treated by endovascular stent, he developed biliary strictures 13 months later and was treated by iterative Roux-en-Y hepaticojejunostomy. Results of our series demonstrated that simultaneous biliary and arterial surgical repair is safe and effi cient in patients with extrahepatic biliary stenosis associated with arterial stenosis complicating liver transplantation.

Simultaneous arterial and biliary repair after liver transplantation

LIDDO, GUIDO;
2007-01-01

Abstract

The presence of hepatic arterial stenosis (HAS) in patients with biliary strictures (BS) following liver transplantation is common. The treatment of these biliary complications remains diffi cult. The aim of this study is to report 7 patients with BS associated with HAS treated by simultaneous artery and biliary surgical repair. Among 787 OLT performed from 1991 to 2005, 12 patients (1.5%) experienced BS associated with HAS. Retransplantation was indicated in 5 patients with intrahepatic biliary stenosis. In seven cases, with exclusive extrahepatic BS and HAS, simultaneous biliary and arterial repair were considered. Patients, aged from 31 to 60 years, underwent liver transplantation and experienced BS 42 days and HAS 66 days after transplantation. Simultaneous biliary and arterial repair was indicated in the presence of biliary duct to duct stenosis in 6 cases and after Roux-en-Y choledochojejunostomy in one case. All arterial stenosis were more than 50% of the arterial diameter. Six patients had had BS previously treated by plastic prothesis and two had had HAS previously treated by endovascular stent or pneumatic dilation. Arterial repair was the fi rst step of the procedure with a complete resection of the arterial stricture followed by a termino-terminal arterial anastomosis. No graft interposition was needed. In one case stenosis involved only the right hepatic artery while in the 6 other cases the stenosis was located at the site of the anastomosis. In all cases resistance index was > 0.5 on intra-operative doppler ultrasound after reconstruction. Biliary repair included in all cases a Roux-en-Y biliaryjejunostomy. There were no postoperative deaths and morbidity was observed in only one patient. No postoperative biliary fi stulas were observed and the mean hospital length of stay was 16 days. With a mean follow up of 67 months, all patients are alive without graft loss. Recurrent arterial stenosis was discovered in one patient and although successfully treated by endovascular stent, he developed biliary strictures 13 months later and was treated by iterative Roux-en-Y hepaticojejunostomy. Results of our series demonstrated that simultaneous biliary and arterial surgical repair is safe and effi cient in patients with extrahepatic biliary stenosis associated with arterial stenosis complicating liver transplantation.
2007
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11564/369830
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