RESUMO
OBJECTIVES: The authors sought to identify strictures or hepatic artery obstruction with posterior collateral transformation in our series of liver transplantation, treatment, and evolution. The thrombosis or severe hepatic artery stenosis sometimes presents a compensation mechanism, the collateral transformation of the artery. MATERIAL AND METHODS: From April 2002 to December 2011 we collected 18 cases of collateral transformation. We analyzed data regarding the transplantation, diagnosis, treatment, clinical evolution, liver function, and Doppler-ultrasound. RESULTS: The main indication was alcoholic cirrhosis, followed by hepatocellular carcinoma - hepatitis C virus. The mean cold ischemia time was 292.2 minutes mean hot ischemia was 48.8. The anastomosis was performed on the gastroduodenal-splenic patch donor in 14 cases, the celiac trunk in 2 cases, and on grafts to the aorta in another 2. Doppler ultrasound showed 8 cases without complications, 8 with low flows, and 2 cases with alterations of the right hepatic artery. Computed tomographic (CT) angiography was performed in patients with impaired eco-Doppler and found 4 obstructions, 2 cases with kinking, 1 stenosis, and 3 normal cases. Three patients with low flows were re-operated and another re-transplanted. After diagnosis of collateral transformation, all were treated with antiplatelet agents. Two cases of angioplasty were associated. The collaterals were diagnosed 1 month to 44.8 months after transplantation. Five patients died. In the latest data, 10 patients do not have analytical alteration. The Doppler ultrasound shows 7 cases being normal and 6 with flow but low resistances. CONCLUSIONS: In our series, all patients with collateral transformation, except one who was transplanted, maintain good liver function with permeable vessels.
Assuntos
Circulação Colateral/fisiologia , Artéria Hepática , Transplante de Fígado/efeitos adversos , Trombose/fisiopatologia , Carcinoma Hepatocelular/fisiopatologia , Carcinoma Hepatocelular/cirurgia , Artéria Celíaca/cirurgia , Angiografia por Tomografia Computadorizada , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Ecocardiografia Doppler , Hepatite C Crônica/fisiopatologia , Hepatite C Crônica/cirurgia , Humanos , Cirrose Hepática Alcoólica/fisiopatologia , Cirrose Hepática Alcoólica/cirurgia , Neoplasias Hepáticas/fisiopatologia , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Trombose/diagnóstico por imagem , Trombose/etiologia , Doadores de TecidosRESUMO
The prevalence of congenital renal arteriovenous malformations is low; for this reason, they are a very uncommon cause of arterial hypertension. However, arterial hypertension due to congenital renal arteriovenous malformations is potentially curable; thus, it is important to reach the correct diagnosis so that the natural course of the hypertension refractory to drug therapy can be modified. We present a case of a patient with bilateral congenital renal arteriovenous fistulas that were treated with two different embolization techniques in function of the morphology of the fistula and the intensity of the flow; treatment achieved control of the clinical symptoms of hypertension.