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Doppler Ultrasound Findings in the Hepatic Artery Shortly After Liver Transplantation

¹ Department of Radiology, Clinic Hospital of Barcelona, Villarroel 170, 08036 Barcelona, Spain.

View larger version (59K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Color Doppler ultrasound study in 57-year-old woman 24 hours after grafting shows patent hepatic artery. Pulsed Doppler ultrasound at intrahepatic level (arrow) shows normal waveform with resistive index of 0.76.

View larger version (70K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —On second day after liver transplantation in 61-year-old woman, Doppler waveform of hepatic artery at hilus (arrow) shows high-resistance flow with presence of diastolic phase (resistive index of 0.88). This is waveform type 1 of García-Criado classification [4].

View larger version (46K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —Absence of diastolic phase with normal systolic phase in Doppler waveform of hepatic artery 24 hours after liver transplantation in 58-year-old man (resistive index = 1), waveform type 2.

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —Doppler ultrasound of hepatic artery at hilus (arrow) 24 hours after liver transplantation in asymptomatic 44-year-old man shows high-resistance flow in hepatic artery without diastolic phase, as in Figure 3; but in this patient diminished systolic velocity (type 3) is also present.

View larger version (58K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Ultrasound of liver graft in 56-year-old man with hepatic artery thrombosis. Color Doppler ultrasound shows absence of flow in hepatic artery at hilus (arrow).

View larger version (62K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Ultrasound of liver graft in 56-year-old man with hepatic artery thrombosis. No arterial flow is detected on pulsed Doppler ultrasound.

View larger version (57K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —Ultrasound of liver graft in 56-year-old man with hepatic artery thrombosis. Contrast-enhanced ultrasound reveals no arterial perfusion in early phase at hilus level (arrow) nor at intrahepatic level.

View larger version (50K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —Ultrasound of liver graft in 56-year-old man with hepatic artery thrombosis. Later phase after contrast injection shows normal portal perfusion but no flow in hepatic artery.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5E —Ultrasound of liver graft in 56-year-old man with hepatic artery thrombosis. Thrombosis of hepatic artery is confirmed at angiography.

View larger version (89K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —Hepatic artery stenosis in 39-year-old man. Doppler ultrasound of hepatic artery at intrahepatic level shows prolonged acceleration time of 0.153 second.

View larger version (89K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —Hepatic artery stenosis in 39-year-old man. Flow of intrahepatic artery shows diminished pulsatility and small difference between systolic and diastolic velocities that result in low resistive index of 0.40.

View larger version (77K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —Hepatic artery stenosis in 39-year-old man. Pulsed Doppler ultrasound shows elevation of blood flow velocity (2.99 m/s) at stenotic level.

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —Hepatic artery stenosis in 39-year-old man. Arteriography confirmed hepatic artery stenosis.

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —Pseudoaneurysm of hepatic artery in 60-year-old woman after liver transplantation. B-mode ultrasound reveals small fluid-liquid collection of 2 x 0.9 cm (arrow) at hilus.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —Pseudoaneurysm of hepatic artery in 60-year-old woman after liver transplantation. Color Doppler ultrasound shows complete filling of collection with turbulent flow (arrow). Note situation of collection above main portal vein (arrowhead), which is usual location of hepatic artery.

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —Pseudoaneurysm of hepatic artery in 60-year-old woman after liver transplantation. Arteriography confirms diagnosis of pseudoaneurysm.

View larger version (55K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —Splenic artery steal syndrome in 53-year-old man 4 days after liver transplantation. Color Doppler ultrasound does not detect hepatic artery.

View larger version (53K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —Splenic artery steal syndrome in 53-year-old man 4 days after liver transplantation. No arterial flow is identified on pulsed Doppler ultrasound in usual location of hepatic artery.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8C —Splenic artery steal syndrome in 53-year-old man 4 days after liver transplantation. Contrast-enhanced ultrasound (SonoVue) shows patent hepatic artery (arrow). Note that filling of hepatic artery is delayed; also note simultaneous filling of portal vein.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8D —Splenic artery steal syndrome in 53-year-old man 4 days after liver transplantation. After contrast administration, hepatic artery flow is detected on pulsed Doppler ultrasound.

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8E —Splenic artery steal syndrome in 53-year-old man 4 days after liver transplantation. Arteriography reveals sluggish flow at hepatic artery (arrow) associated with early and intense filling of splenic artery (arrowhead), which is enlarged.

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8F —Splenic artery steal syndrome in 53-year-old man 4 days after liver transplantation. Selective angiography of hepatic artery shows normal vessel (arrow).

View larger version (71K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8G —Splenic artery steal syndrome in 53-year-old man 4 days after liver transplantation. After surgical occlusion of splenic artery, hepatic arterial flow is normalized.

View larger version (87K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —Spleen ultrasound findings in 55-year-old woman with splenic arterial steal syndrome. B-mode ultrasound shows splenomegaly.

View larger version (93K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —Spleen ultrasound findings in 55-year-old woman with splenic arterial steal syndrome. Enlarged splenic artery in its entire course is seen on B-mode ultrasound (arrow). Figure shows splenic artery near its origin. Note location of aorta (arrowhead) and mesenteric artery (double arrowhead).

View larger version (72K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9C —Spleen ultrasound findings in 55-year-old woman with splenic arterial steal syndrome. Pulsed Doppler ultrasound shows high blood flow velocity in splenic artery at its origin (C) and at splenic hilus (D), with maximum velocities of 2 m/s for entire course.

View larger version (74K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9D —Spleen ultrasound findings in 55-year-old woman with splenic arterial steal syndrome. Pulsed Doppler ultrasound shows high blood flow velocity in splenic artery at its origin (C) and at splenic hilus (D), with maximum velocities of 2 m/s for entire course.

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