What is the role of imaging in the diagnosis of hepatic artery stenosis (HAS) following whole-liver orthotopic liver transplantation (OLTX)?

Updated: Mar 01, 2019
  • Author: Fazal Hussain, MD, MPH; Chief Editor: John Karani, MBBS, FRCR  more...
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Answer

Doppler US is used to screen for HAS. [4, 5] If the surgical anastomosis can be interrogated directly, stenosis is diagnosed if peak systolic velocity exceeds 200-300 cm/s. Upstream from the stenosis, an abnormal pattern of high resistance and low velocity can be detected. Turbulence is encountered within 1-2 cm downstream of the narrowing.

In most patients, direct Doppler evaluation of hepatic artery anastomosis is not possible, because the donor-recipient arterial anastomosis is tortuous, because it is in an inconsistent position, and because it is usually obscured by overlying bowel gas. However, similar to HAT, hemodynamically significant HAS results in intrahepatic arterial tardus parvus waveform morphology. Using an RI of less than 0.5 in conjunction with an SAT of 0.08 second or longer yields a sensitivity of 45% for the detection of HAS. The sensitivity increases to 70% if 2 of the following 3 criteria are present:

  • RI of less than 0.5

  • SAT of 0.08 second or longer

  • Peak systolic velocity of greater than 200 cm/s at the anastomotic site

Because the specificity of Doppler is only 64% in detecting marked arterial disease (ie, HAT or hemodynamically significant HAS), angiography usually is required to confirm the diagnosis. [28, 29] At the time of diagnostic angiography, a decision can be made regarding the effectiveness of percutaneous correction of documented HAS.


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