What is the role of imaging in the diagnosis of inferior vena cava (IVC) complications following whole-liver orthotopic liver transplantation (OLTX)?

Updated: Mar 01, 2019
  • Author: Paul D Russ, MD; Chief Editor: John Karani, MBBS, FRCR  more...
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Answer

Answer

US is the imaging study of choice for screening for IVC complications. A stenosis is detected as a gray-scale narrowing with a 3- to 4-fold increase in velocity on spectral Doppler analysis and associated color Doppler aliasing. Indirect findings of suprahepatic IVC stenosis or thrombosis include distention of the hepatic veins (HVs) with dampening of the hepatic venous spectral Doppler waveform and loss of its usual phasicity. Hemodynamically significant IVC stenosis can be differentiated from pseudostenosis by the presence of features of Budd-Chiari syndrome and elevated Doppler velocity measurements.

Stenosis and thrombosis of the IVC can be detected by using CT scans. Findings include narrowing of the retrohepatic segment, demonstration of an intraluminal thrombus, distention of the IVC and HVs, and imaging features of Budd-Chiari syndrome and/or portal hypertension. Analogous changes can be depicted with MRI and MRV.

Inferior venacavographic results can confirm stenosis and thrombosis. Pressure gradient measurements can distinguish physiologically significant lesions from pseudostenoses. Balloon angioplasty and stent placement can be used to correct an IVC stenosis, but restenosis requiring repeat angioplasty with high-pressure balloon catheters is not uncommon.

Isolated complications of the HV are rare. Strictures at the suprahepatic caval anastomosis can involve the confluence of the HV. Like caval strictures, lesions of this vein are amenable to percutaneous transjugular angioplasty and stent placement.


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