Doppler ultrasonography in living donor liver transplantation recipients: Intra- and post-operative vascular complications

Figure 21 Post-operative developmental portal vein stenosis in a patient with attack of variceal bleeding, 1-year post-living donor liver transplantation. A: B-mode and pulsed Doppler image showing tight PV anastomotic stricture (arrows) and anastomotic jet (> 10-fold) compared to the pre-anastomotic velocity; B: MSCT angiography image demonstrating tight PV anastomotic stricture with aneurysmal dilatation of the left gastric vein; C: Percutaneous trans-hepatic portography demonstrating tight PV stricture and dilated left gastric vein, stealing the portal flow. The pressure gradient was 10 mmHg; D: Control portography after balloon dilatation and stent placement demonstrating wide anastomosis, normalization of the pressure gradient, improvement of the flow steal and disappearance of the left gastric vein filling; E: Color Doppler image after PV stent placement confirming improved portal flow with increased pre-anastomotic velocity and mild elevation of the anastomotic velocity. PV: Portal vein; LGV: Left gastric vein.