Evaluation of the clinical outcome of interventional treatment of venous outflow tract obstruction after autologous liver transplantation for hepatic alveolar larvae

doi:10.3877/cma.j.issn.2095-5782.2025.02.005

Abstract

Abstract:

Objective

To assess the clinical outcome of balloon dilatation or stent placement for the treatment of venous outflow tract obstruction after ex vivo liver resection and autotransplantation （ELRA）for hepatic vesicular echinococcosis.

Methods

Eighteen patients admitted to our interventional radiology department from January 2020 to April 2024 after ELRA for hepatic encapsulation due to stenosis or occlusion of the inferior vena cava and hepatic vein were retrospectively analyzed.Patients were monitored for intraoperative changes in inferior vena cava and hepatic vein pressures， postoperative liver function （AST， ALT，bilirubin， albumin， etc.）， lower extremity edema， and peritoneal effusion.

Results

Eighteen patients （12 males and 6 females） underwent endovascular treatment.Ten cases underwent simple balloon dilatation and achieved good efficacy； eight cases who were poorly treated with balloon dilatation and opted for stenting achieved better efficacy after the operation.Eighteen patients underwent a total of 36 interventions， with a technical success rate of 100% （36/36）.The pressure gradient of the hepatic venous outflow tract was reduced from 25.43±3.96 to 15.24±5.37 mmHg （P＜0.001）； inferior vena cava pressure decreased from 20.67±5.54 to 12.00±4.58 mmHg（P＜0.001）.The changes in hepatic vein and inferior vena cava pressure before and after balloon dilatation or stent placement were statistically significant.There was no statistically significant difference in the liver function indexes such as AST， ALT， bilirubin， and albumin compared with the preoperative period.All patients' clinical symptoms have improved after one or more interventions.

Conclusion

Balloon dilatation or stent placement for the treatment of postoperative venous outflow tract obstruction after ELRA is simple and efficacious.It would be the preferred treatment option for postoperative venous outflow tract obstruction after ELRA.

Key words: Hepatic vesicular echinococcosis, Inferior vena cava stenosis, Hepatic vein stenosis, Intervention

Diwen Zhu, Wenjun Chen, Liang Chen, Hao Li, Yingjun Bao, Yifan Li, Qiang Guo, Junpeng Gu, Weixin Ren. Evaluation of the clinical outcome of interventional treatment of venous outflow tract obstruction after autologous liver transplantation for hepatic alveolar larvae[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2025, 13(02): 123-127.

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URL: https://zhjrfsxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-5782.2025.02.005

https://zhjrfsxdzzz.cma-cmc.com.cn/EN/Y2025/V13/I02/123

Figures/Tables 4

项目	数据
性别（男性/女性，例）	12/6
年龄（岁， $\overset{ˉ}{x}$ ± s ）	37.56±10.12
腹水及下肢水肿情况［例（%）］	18（100.0）
手术次数［例（%）］
1次	11（61.1）
2次	1（5.6）
3次	3（16.7）
4次	1（5.6）
5次	2（11.1）
狭窄部位［例（%）］
单纯下腔静脉狭窄	4（22.2）
单纯肝静脉狭窄	7（38.9）
下腔静脉、肝静脉狭窄	7（38.9）
手术方案（次）
下腔静脉球囊扩张	10
肝静脉球囊扩张	5
下腔静脉支架置入	3
肝静脉支架置入	4
下腔静脉、肝静脉球囊扩张	11
下腔静脉球囊扩张、肝静脉支架置入	3

项目	数据
性别（男性/女性，例）	12/6
年龄（岁， $\overset{ˉ}{x}$ ± s ）	37.56±10.12
腹水及下肢水肿情况［例（%）］	18（100.0）
手术次数［例（%）］
1次	11（61.1）
2次	1（5.6）
3次	3（16.7）
4次	1（5.6）
5次	2（11.1）
狭窄部位［例（%）］
单纯下腔静脉狭窄	4（22.2）
单纯肝静脉狭窄	7（38.9）
下腔静脉、肝静脉狭窄	7（38.9）
手术方案（次）
下腔静脉球囊扩张	10
肝静脉球囊扩张	5
下腔静脉支架置入	3
肝静脉支架置入	4
下腔静脉、肝静脉球囊扩张	11
下腔静脉球囊扩张、肝静脉支架置入	3

时间	例数	下腔静脉压力（mmHg）	肝静脉压力（mmHg）	AST（U/L）	ALT（U/L）	白蛋白g/L	胆红素（μmol/L）
术前	18	20.67±5.54	25.43±3.96	33.32±11.49	28.20±15.03	28.56±6.75	21.62±16.51
术后	18	12.00±4.58	15.24±5.37	34.99±11.60	30.55±19.30	27.26±5.48	24.82±19.73
t值		10.316	8.674	-1.794	-1.521	1.978	-1.978
P值		＜0.001	＜0.001	0.081	0.137	0.056	0.056

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