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At least 649 records · Page 36Linked to original sources
PubMed2000

Early vascular complications after pediatric liver transplantation.

Vascular complications have a detrimental effect on the outcome after liver transplantation. Most studies focus exclusively on hepatic artery thrombosis (HAT). The current study analyzed the incidence, consequences, and risk factors for HAT, portal vein thrombosis (PVT), and venous outflow tract obstruction (VOTO) in a consecutive series of 157 pediatric liver transplantations. The overall incidence of vascular complications was 21%. The incidences of HAT, PVT, and VOTO were 10%, 4%, and 6%, respectively. Patient survival after PVT and VOTO and graft survival after HAT and PVT were less compared with survival of grafts without vascular complications. To identify risk factors for vascular complications, factors related to recipient, donor, and surgical techniques were analyzed. A low donor-recipient (D/R) age ratio, long surgical time, and use of the proper hepatic artery of the recipient for arterial reconstruction were risk factors for HAT. Young age, low weight, segmental grafts, and piggyback technique were risk factors for PVT. Fulminant hepatic failure, high D/R age and weight ratios, and use of segmental grafts were related to VOTO. Vascular complications, which occurred in 21% of the pediatric liver transplantations, had a significant impact on patient and graft survival. Size disparity between donor and recipient was an important risk factor for vascular complications, especially in the case of transplantation of segmental grafts. Patient and graft survival might improve by avoiding the identified risk factors.

Adolescent↗
PubMed2000

Portal vein thrombosis caused by microwave coagulation therapy for hepatocellular carcinoma: report of a case.

Microwave coagulation therapy (MCT) is one of the treatment modalities for patients with hepatocellular carcinoma (HCC). A 67-year-old man with liver cirrhosis underwent MCT during a laparotomy for a deeply located HCC (2.5 cm in diameter) at the border of the anterior and posterior segments of the right hepatic lobe. Two weeks after MCT, he complained of abdominal fullness. Portal vein thrombosis (PVT) was diagnosed because he had massive ascites and an echogenic mass in the portal vein on abdominal ultrasonography. PVT was successfully treated by fibrinolytic therapy with a selective infusion of urokinase via the superior mesenteric artery (SMA). There have been few reports on PVT as a complication of MCT. Attention should be paid to the possible occurrence of PVT as a critical complication after MCT for liver tumors adjacent to the portal vein. Fibrinolytic therapy via the SMA is thus considered to be an effective approach for PVT after MCT.

Aged↗
PubMed1986

Review of computed tomography findings in thrombosis of the major abdominal venous pathways.

Computed tomography is commonly the first diagnostic modality to detect venous thrombosis. The relatively constant location and anatomic relations of the major abdominal veins allow for their proper recognition and differentiation from other tubular structures. Whether the occlusion is secondary to blood clot or tumor extension, the vessels demonstrate a characteristic appearance. The presence of adjacent tumor mass is the single most important factor to differentiate the two types of thrombi. Invaluable aid is provided by computed tomography in the management of this clinical situation. Uncommonly, the diagnosis remains unclear and venography must be done. Selected examples of major abdominal venous thrombosis are presented.

Abdomen↗
PubMed2004

Asymptomatic process of hepatic artery thrombosis in a patient after orthotopic liver transplantation.

BACKGROUND: Hepatic artery thrombosis is one of the serious complications after liver transplantation. It will mostly cause a failure of the transplantation. This case of hepatic artery thrombosis showed a stable clinical course and minimal histological change, and now has been surviving for 4 years with normal liver function. We investigated the possible causes for asymptomatic hepatic artery thrombosis in one patient after orthotopic liver transplantation (OLT) and discussed the diagnosis of ischemia of OLT pathologically and clinically. METHODS: Liver function test, color Doppler ultrasonography, and hepatic arteriography were performed during the development of hepatic arteriothrombosis. Possible factors for the asymptomatic process of the thrombosis were analyzed. RESULTS: On the 4th postoperative day, thrombosis formed at the anastomotic stoma of the hepatic artery, and on the 11th postoperative day, the artery was completely occluded. Serial liver biopsies revealed intrahepatic cholestasis, hydropic degeneration of hepatocytes, atrophy of the biliary epithelium, and fibrosis in the portal area. Monitoring of liver function showed nothing abnormal except elevation of gamma-GT and ALP levels. On the 71st day after OLT, arteriography demonstrated that the hepatic artery remained completely occluded in addition to the establishment of collateral circulation and compensation of the portal vein. The patient didn't show any symptoms of arterial thrombosis. CONCLUSION: Collateral circulation and compensation of the portal vein are beneficial to allograft survival and avoidance of retransplantation after thrombosis of the hepatic artery. Color Doppler ultrasonography within 2 weeks after OLT is helpful to the early diagnosis of hepatic arteriothrombosis.

Adult↗
PubMedDate not supplied

Portal thrombosis due to intrahepatic cholangiocarcinoma following successful treatment for hepatocellular carcinoma.

A 57-year-old man, who had undergone hepatic arterial infusion chemotherapy with right portal occlusion for hepatocellular carcinoma was admitted to our hospital because of severe abdominal pain. Contrast-enhanced computed tomograms revealed that most areas of the liver were not enhanced, a finding suspicious for perfusion disturbance in the liver. Angiography revealed an interrupted right hepatic artery. Arterial portograms revealed complete obstruction of the right portal vein and a small left branch of the portal vein. Despite anticoagulant therapy with urokinase for portal vein thrombosis, the patient died from hepatorenal failure. Autopsy revealed that cholangiocarcinoma occupied almost the entire parenchyma of the right lobe, although the treated hepatocellular carcinoma lesion was completely necrotic. The right hepatic artery was obstructed due to direct invasion of tumor. There were diffuse thrombi in the left portal branches surrounded by tumor infiltrating along Glisson's sheath to the peripheral portion of the left lobe.

Bile Duct Neoplasms↗
PubMed2004

Pulmonary artery aneurysm in Behcet's disease: a case report.

The pulmonary artery is the second most common site of arterial involvement in Behcet's disease. A 32-year-old man presented with bilateral ankle edema, abdominal discomfort, and hemoptysis. He had a history of recurrent oral and genital aphthous ulcerations for 1 year. The diagnosis of Behcet's disease was made on the basis of the criteria published by the International Study Group for Behcet's Disease. His chest X-ray revealed left hilar enlargement. A helical computed tomography (CT) scan showed a pulmonary aneurysm with intramural thrombosis in the left pulmonary artery and enlarged hepatic veins. Treatment with colchicine and cyclophosphamide was given for 24 months, and helical thoracic CT was performed again. Helical CT showed that the pulmonary aneurysm was reduced by treatment. Helical CT could be used in Behcet's disease for the diagnosis and follow-up of pulmonary involvement.

Adult↗
PubMed1998

Current status of intestinal transplantation in children.

PURPOSE: A clinical trial of intestinal transplantation (Itx) under tacrolimus and prednisone immunosuppression was initiated in June 1990 in children with irreversible intestinal failure and who were dependent on total parenteral nutrition (TPN). METHODS: Fifty-five patients (28 girls, 27 boys) with a median age of 3.2 years (range, 0.5 to 18 years) received 58 intestinal transplants that included isolated small bowel (SB) (n = 17), liver SB (LSB) (n=33), and multivisceral (MV) (n=8) allografts. Nine patients also received bone marrow infusion, and there were 20 colonic allografts. Azathioprine, cyclophosphamide, or mycophenolate mofetil were used in different phases of the series. Indications for Itx included: gastroschisis (n=14), volvulus (n=13), necrotizing enterocolitis (n=6), intestinal atresia (n=8), chronic intestinal pseudoobstruction (n=5), Hirschsprung's disease (n=4), microvillus inclusion disease (n=3), multiple polyposis (n=1), and trauma [n=1). RESULTS: Currently, 30 patients are alive (patient survival, 55%; graft survival, 52%). Twenty-nine children with functioning grafts are living at home and off TPN, with a mean follow-up of 962 (range, 75 to 2,424) days. Immunologic complications have included liver allograft rejection (n=18), intestinal allograft rejection (n=52), posttransplant lymphoproliferative disease (n=16), cytomegalovirus (n=16) and graft-versus-host disease (n=4). A combination of associated complications included intestinal perforation (n=4), biliary leak (n=3), bile duct stenosis (n=1), intestinal leak (n=6), dehiscence with evisceration (n=4), hepatic artery thrombosis (n=3), bleeding (n=9), portal vein stenosis (n=1), intraabdominal abscess (n=11), and chylous ascites (n=4). Graft loss occurred as a result of rejection (n=8), infection (n=12), technical complications (n=8), and complications of TPN after graft removal (n=3). There were four retransplants (SB, n=1; LSB n=3). CONCLUSIONS: Intestinal transplantation is a valid therapeutic option for patients with intestinal failure suffering complications of TPN. The complex clinical and immunologic course of these patients is reflected in a higher complication rate as well as patient and graft loss than seen after heart, liver, and kidney transplantation, although better than after lung transplantation.

Child, Preschool↗
PubMed1978

[Retrograde pancreatic phlebography with simultaneous balloon occlusion of portal and arterial flow. An experimental study (author's transl)].

The possibility of demonstrating the venous system of the entire pancreas by retrograde portal contrast injection with simultaneous balloon occlusion of the portal vein, coeliac axis and superior mesenteric artery was investigated in 12 dogs. In seven cases good filling of the larger pancreatic veins was obtained. Portal and arterial pressure relationships altered considerably during various experimental conditions. A rise in serum transaminases was observed only once when there was thrombosis of the portal vein and branches of the hepatic veins. Apart from this, there was no rise in transaminases or alphaamylase. Histologically there were only minor changes in the liver after total occlusion of 40 minutes, the occlusion having been performed over periods of six minutes with two to five minutes of flow alternating. The application of this method to man is discussed.

Animals↗
PubMed1989

[Ultrasonic diagnosis following liver transplantation].

Realtime and duplex sonography were used routinely for the postoperative and long-term follow-up of liver transplantation patients. In the early postoperative period 90 patients exhibited diffuse (67.7%) and focal (33.3%) alterations of the liver parenchyma; in 53% of patients various liquid lesions were diagnosed in the abdominal cavity. In case of diffuse alterations of the liver parenchyma, no correlation could be established between sonomorphology and histopathologic findings; especially rejection could not be diagnosed by using sonography. In case of focal intrahepatic lesions highly echogenic areas of infarction could be differentiated from poorly echogenic changes such as necrosis, haematoma and abscess--these entities had to be further distinguished by means of CT or needle biopsy. 20 patients showed biliary pathology (biliomas: 5, cholangiectasis: 15). In 73.3% of cholangiectasis the cause of obstruction could be demonstrated sonographically (biliary thrombus, stenosis of the anastomosis of the common bile duct, recurrence of tumour). In 13 patients major vascular complications were diagnosed predominantly by means of duplex sonography (hepatic artery occlusion: 4, hepatic artery stenosis: 1, portal vein occlusion: 1, partial thrombosis of portal vein: 2, portal vein stenosis: 2, stenosis with incomplete thrombosis of the inferior vena cava: 3, VCI stenosis: 1). 13 patients developed recurrent malignancy in the late postoperative period.

Adolescent↗
PubMed1979

A review of the complications of burns, their origin and importance for illness and death.

Complications are the major causes of illness and death after burning and most of them stem from the burn wound. Their origin and importance are reviewed with emphasis on problems and growing points in knowledge. Fluid leakage from the circulation into the burn is the cause of hypovolemic shock, but the underlying permeability changes in the burn are only partly understood. Other nonbacterial complications include acute cardiac failure, acute anemia, hemolytic jaundice, renal failure, encephalopathy, complex hypermetabolic effects including pseudodiabetes, gastric and duodenal ulceration, deep vein thrombosis and pulmonary embolism, pulmonary and glomerular microthrombosis, hepatic jaundice, and arterial thrombosis. Involvement of the airway in conflagrations carries special hazards like glottic edema and inhalation of irritant fumes. Nowadays, bacterial causes are dominant and these remain the main challenge. Bacterial infection and invasion of the burn are usually responsible for septicemia, bronchopneumonia, and pyelonephritis although other sources also contribute. Indirect manifestations of septicemia include paralytic ileus, acute gastric dilatation, toxic myocarditis, and some cases of renal failure. Therapeutic complications like agranulocytosis, thrombocytopenia, and colitis occur at times. High concentrations of oxygen given therapeutically can produce fatal aseptic hypoxic pneumonitis.

Burns↗
PubMed1993

Upper inferior vena caval anastomotic stenosis in liver transplant recipients: Doppler US diagnosis.

Ultrasound (US) is routinely used as a screening tool for liver transplant dysfunction. Its use in the detection of significant vascular complications of liver transplantation such as thrombosis or stenosis of the hepatic artery and portal vein is well recognized. Its role in the detection of anastomotic stenosis of the inferior vena cava (IVC) has not been defined. The authors present US findings in five patients with such stenosis. The gray-scale and Doppler findings in all cases consisted of loss of normal hepatic vein and IVC periodicity. Some studies also showed distention of the hepatic veins and IVC and a high-velocity jet at the anastomosis, and in one case the stenosis was visualized with color Doppler US. While there are other causes of absent periodicity in the hepatic veins, this finding in the appropriate clinical setting may be a sensitive indicator of upper IVC anastomotic stenosis.

Adolescent↗
PubMed1999

Entrapment of a Swan Ganz catheter in an IVC filter requiring caval exploration. A case report.

The placement of Swan Ganz (SW) catheters and inferior vena cava (IVC) filters are common procedures performed in critically ill patients. Many reports describe the independent misplacement of SG catheters and IVC filters, and others have reported migration of IVC filters and entanglement of various intravascular devices in IVC filter. Our patient is a 70-year-old Caucasian woman who underwent an aortic valve replacement and coronary artery bypass grafting. The patient developed a deep venous thrombosis and an infrarenal IVC filter was placed without incident. A Swan Ganz catheter was placed later in the postoperative period and became entangled in the IVC filter. We advised operative removal after several unsuccessful percutaneous attempts to retrieve the catheter. IVC filters are indicated for prevention of fatal pulmonary emboli in patients with a contraindication to anticoagulants or with recurrent embolism despite adequate anticoagulant therapy. Complications of IVC filters include caval thrombosis, retroperitoneal hemorrhage and perforation of the IVC, hepatic veins, duodenum and aorta. We describe our evaluation and operative approach and make recommendations for prevention of entangling the SG into the IVC filter.

Aged↗
PubMed2002

Diagnosis by ultrasonography of congestion of the caudal vena cava secondary to thrombosis in 12 cows.

This paper describes the clinical, ultrasonographic, radiographic and postmortem findings in 12 cows with thrombosis of the caudal vena cava. The principal clinical signs were chronic bronchopneumonia and fever in 11 cows; one cow had epistaxis and one cow bled from the mouth; eight cows had anaemia and leucocytosis, and the clotting time for the glutaraldehyde test was markedly decreased in all the cows; in nine of the cows the activity of gamma-glutamyltransferase was high, suggesting chronic hepatic congestion. The most important ultrasonographic finding was congestion of the caudal vena cava attributable to thrombosis of the vein. In all the cows the caudal vena cava was round to oval on cross-section, rather than the normal triangular shape. The hepatic, splenic and portal veins were dilated in five, three and one cow, respectively. The results of radiography and endoscopy supported a diagnosis of bronchopneumonia, but there were radiographic changes in the diaphragmatic lung lobes that supported a diagnosis of vena caval disease in only four cows. Postmortem there was a thrombosis of the caudal vena cava in all the cows, and the thrombi were located in the thoracic, subphrenic and abdominal part of the caudal vena cava at the level of the liver in four, one and seven cows, respectively. In three cows, the thrombus was situated where a hepatic abscess had broken into the caudal vena cava, and in one cow it was at the site of a diaphragmatic abscess. In another cow, there was a fistula between the major bronchus of the right diaphragmatic lung lobe and the caudal vena cava where the thrombus was situated. Three cows had liver abscesses that had not broken into the caudal vena cava. There was severe bronchopneumonia in 11 of the cows, some of which also had multiple pulmonary abscesses.

Animals↗
PubMedDate not supplied

Percutaneous radiofrequency ablation of hepatocellular carcinoma in the presence of portal vein thrombosis.

Portal vein thrombosis (PVT) may not be an absolute contraindication for hepatic radiofrequency ablation (RFA). Although the data are sparse, PVT is commonly considered a contraindication to RFA. PVT has actually been described as a complication following RFA. RFA was used to treat a 3.9 x 2.9 cm primary hepatocellular carcinoma (HCC) in a patient with concomitant PVT without complication. RFA can be safely performed in this setting but further studies could clarify this issue.

Carcinoma, Hepatocellular↗
PubMed2006

Mesocaval stenting for therapy of portal hypertension after orthotopic liver transplantation.

A 20-year-old patient underwent liver transplantation (LT) because of chronic hepatitis-associated cirrhosis. After transplantation, the patient developed partial portal vein thrombosis without deterioration of liver function. However, in the long-term follow-up, the patient developed refractory portal hypertension with recurrent episodes of severe upper gastrointestinal bleeding. Extensive nonoperative treatment including multiple esophageal ligatures and sclerotherapy was not successful. Thus, the patient had to be treated surgically with a mesocaval H-shunt. Pathophysiology, therapy and prognosis of this rare complication after LT are discussed with regard to the literature.

Adult↗