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

Figure 31 Post-operative hepatic artery thrombosis 4 d post-living donor liver transplantation in a patient with shooting liver enzymes. A: Color US image, showing abrupt occlusion of the HA at the graft hilum (arrow) and absence of intra-hepatic flow; B: MDCT angiography, volume rendering image, showing complete occlusion of the HA proximal to the anastomosis and non-filling of the intra-hepatic branches (arrow); C: Digital subtraction angiography image, confirming complete thrombosis of the HA proper (arrow); D: Control angiography after thrombolysis with tissue plasminogen activator, showing resolution of the thrombus and filling of the intrahepatic branches. There was mild size mismatch noted at the anastomotic site (arrow) with no underlying stricture; E: Color Doppler image performed during the procedure after HA recanalization, showing normal biphasic flow inside the graft confirming absence of significant stenosis, therefore stent placement was not necessary. HA: Hepatic artery; GDA: Gastroduodenal artery.