Diagnostic Ultrasound - Abdomen and Pelvis

Liver Transplant Hepatic Venous Stenosis/Thrombosis
Diagnoses: Liver
IMAGING
• Hepatic venous stenosis
○ Color Doppler
– May see focal turbulent flow at stenosis and stenotic
jet
○ Spectral Doppler
– Elevated velocity at site of stenosis or < 10 cm/sec
away from site of stenosis
– Loss of normal triphasic waveform
□ Most commonly monophasic in appearance
– May see secondary slow portal vein velocity
○ Angiography
– Pressure gradient > 5 mm Hg across stenosis
• Hepatic venous thrombosis
○ Direct visualization of thrombus in hepatic vein or lack of
detectable flow with color, power, or spectral Doppler
KEY FACTS
PATHOLOGY
• Hepatic vein or IVC stenosis results in outflow obstruction
of liver
• Immediate post-transplant period
○ Kinking of vessel
• Delayed presentation
○ Intimal hyperplasia
CLINICAL ISSUES
• Hepatic vein stenosis occurs in < 1% of liver transplants, 2-
10% of liver transplants when piggy-back technique used
• Clinical presentation: Lower extremity edema, Budd-Chiari
syndrome, ascites
• Treatment
○ Stenosis may be treated with balloon-expandable stents
or angioplasty
○ Thrombosis may require surgery or retransplant
(Left) Graphic shows stenosis
at the piggyback anastomosis
ſt in a liver transplant. In this
technique, the donor
suprahepatic IVC is
anastomosed with the
recipient common orifice of all
three hepatic veins. (Right)
Spectral Doppler in the right
hepatic vein shows
monophasic st nonpulsatile
waveform. When waveforms
that were previously pulsatile
become monophasic, a
stenosis of the hepatic
venous/IVC anastomosis
should be suspected and
warrants further evaluation.
(Left) Catheter injection of the
right hepatic vein (same
patient) shows that contrast
fills the hepatic vein but
does not reflux readily into the
IVC , indicative of stenosis,
which was subsequently
balloon angioplastied. (Right)
Spectral Doppler of the right
hepatic vein in the same
patient after balloon dilation
shows increase in pulsatility as
well as increased magnitude
of flow .
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