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HEPATIC ARTERY THROMBOSIS (FIG. 93-1)
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Interrupts the graft blood supply:
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Presentation in the early/immediate postoperative period differs from instances of delayed thrombosis”
Most of the irrigation of the biliary tree is derived from the hepatic artery.
Usually occurs within the first 2 months
More frequent in the pediatric population
Major cause of graft loss in the early postoperative period
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Most cases of hepatic artery thrombosis do not have a clear cause
Low hepatic artery flow: less than 350 mL/minute
Age: Less than 1 year
Weight: Below 10 kg
ABO-incompatible grafts
Medial arcuate ligament syndrome
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Early diagnosis may prevent graft loss and potential recipient mortality.
Abrupt and marked elevation of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) enzymes are indicators of early HAT.
Serum total bilirubin, alkaline phosphatase, and gamma glutamyltransferase (GGT) levels are sensitive indicators of late HAT.
Radiology studies:
Doppler ultrasonography is used in the immediate postoperative period to screen for HAT or hepatic artery stenosis.
Contrast-enhanced ultrasonography is more accurate,
Computed tomography (CT) angiography is used to confirm the diagnosis
Multiphase, multislice CT angiography with multidetector reconstruction (sensitivity close to arteriography) (Fig. 93-2)
Magnetic resonance angiography (MRA) with contrast
Arteriography: Gold standard
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Daily routine Duplex Doppler Ultrasound evaluation in the first postoperative day that can be repeated as considered necessary.
HAT in the immediate postoperative period is a surgical emergency and requires immediate re-exploration to attempt thrombectomy.
Early diagnoses allow revascularization of the HAT through thrombectomy.
When thrombosis has been present for over 24-48 hours, revascularization is not usually ...