04 August 2020 : Original article
Inferior Vena Cava Constriction After Liver Transplantation Is a Severe Complication Requiring Individually Adapted Treatment: Report of a Single-Center Experience
Jan-Paul Gundlach1CDEF*, Rainer Günther2B, Marcus Both3BD, Jens Trentmann3BD, Jost Philipp Schäfer3BCD, Jochen T. Cremer4B, Christoph Röcken5BDE, Thomas Becker1DEG, Felix Braun1ABD, Alexander Bernsmeier1CDEDOI: 10.12659/AOT.925194
Ann Transplant 2020; 25:e925194
Table 3 Diagnostic and therapeutic procedures in case of IVC occlusion.
# | Time | Radiologic finding | ΔP before | ΔP after | treatment option | Specific anticoagulation | follow-up |
---|---|---|---|---|---|---|---|
1 | 1.5 m | US + cavography: thrombus + fibrotic stenosis of suprahepatic anastomosis | 14 mmHg | 0 mmHg | Transthoracic thrombectomy, balloon protection, AV fistula + delayed PTA (after 2w) | None LMWH | 50 m |
2 | 16 d | LMWH prophylaxis | 16 d † | ||||
3 | 4 m | CT: stenosis and thrombus | Transatrial thrombectomy + augmentation | Rivaroxaban | 19 m | ||
4 | 1 m | US + cavography: stenotic IVC due to kinking | 5 mmHg | Without intervention | None | 6 m † | |
5 | 11 d | CT: stenotic IVC anastomosis after 11 d | 10 mmHg | 3 mmHg | PTA 9 m post LT | None | 28 m |
6 | 9 m | CT: slit-shaped stenosis of IVC anastomosis, collaterals + varices | 11 mmHg (9 m) | 2 mmHg (12 m) | Without intervention | LMWH prophylaxis | 13 m † |
Time period after LT (time), trans-stenotic pressure gradient before and after intervention (ΔP), time of follow-up as well as the administered postinterventional anticoagulation. d – days; w – weeks; m – month/months; US – ultrasound; ΔP – pressure gradient; LMWH – low-molecular-weight heparin; † – death. |