Impact of Doppler Ultrasound on Diagnosis and Therapy Control of Lienalis Steal Syndrome After Liver Transplantation
Eva M. Teegen, Timm Denecke, Rosa B. Schmuck, Robert Öllinger, Dominik Geisel, Johann Pratschke, Sascha S. Chopra
Department of Surgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
Ann Transplant 2017; 22:440-445
Lienalis steal syndrome is a rare complication after orthotopic liver transplantation leading to severe complications. Routine duplex sonography allows early and safe detection of lienalis steal syndrome and secondarily helps to monitor the outcome by evaluating the hemodynamics.
MATERIAL AND METHODS: This analysis included eight patients who after orthotopic liver transplantation needed splenic artery embolization due to lienalis steal syndrome. Lienalis steal syndrome was assumed in case of elevated transaminases, bilirubinemia or persistent ascites, and the absence of further pathologies. Diagnosis was supported by ultrasound, confirmed by digital subtraction angiography, and followed by splenic artery embolization for treatment. We analyzed blood levels and ultrasound findings before and after splenic artery embolization as well as during follow-up and evaluated for incidence of severe biliary complications and survival.
RESULTS: Arterial resistive index (RI) significantly regularized after splenic artery embolization while the maximum arterial velocity increased. The portal venous flow volume and maximum velocity decrease. Laboratory parameters normalized. Two of eight patients developed ischemic-type biliary disease. Survival rate was 88% over a median follow-up of 33 months.
CONCLUSIONS: Beside unspecific clinical findings, bedside ultrasound examination enabled a quick verification of the diagnosis and allowed direct treatment to minimize further complications. Furthermore, ultrasound can immediately monitor the therapeutic effect of splenic artery embolization.
Keywords: Hypertension, Portal, Liver Transplantation, Splenic Artery, Ultrasonography, Doppler