Nicolas Golse1,2,3,4, Simone Santoni5, Vincent Karam5, Oriana Ciacio5, Gabriella Pittau5, Marc-Antoine Allard5,6,7,8, Daniel Cherqui5,9,10,6, Antonio Sa Cunha5,6,7,8, René Adam5,6,7,8, Denis Castaing5,9,10,6, Eric Vibert5,9,10,6. 1. AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif Cedex, France. nicolasgolse@me.com. 2. Inserm, Unité 785, 94800, Villejuif, France. nicolasgolse@me.com. 3. Univ Paris-Sud, UMR-S 785, 94800, Villejuif, France. nicolasgolse@me.com. 4. DHU Hepatinov, 94800, Villejuif, France. nicolasgolse@me.com. 5. AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif Cedex, France. 6. DHU Hepatinov, 94800, Villejuif, France. 7. Inserm, Unité 935, 94800, Villejuif, France. 8. Univ Paris-Sud, UMR-S 935, 94800, Villejuif, France. 9. Inserm, Unité 785, 94800, Villejuif, France. 10. Univ Paris-Sud, UMR-S 785, 94800, Villejuif, France.
Abstract
BACKGROUND: Vascular complications following liver transplantation (LT) may result from technical deficiencies. Intraoperative diagnosis remains challenging but can prevent serious delayed complications. Intraoperative Doppler ultrasonography (IOUS) represents the gold standard for imaging, although it requires radiological skills. Contrast-enhanced ultrasonography has been reported during postoperative assessments, but never intraoperatively (CE-IOUS). The aim of this study was to assess the feasibility of routine CE-IOUS, to evaluate its impact on surgical strategy and its usefulness. METHODS: All 553 whole LTs performed in our tertiary centre between 01/2010 and 12/2014 were reviewed. We compared perioperative outcomes and long-term survival in IOUS (n = 370) versus CE-IOUS (n = 103) groups. Secondarily, the seven cases where the two imaging findings conflicted (CE+ Group) were matched 1:2 and compared with an exclusively IOUS procedure (CE- Group, n = 14) to assess the consequences of a specific CE-guided strategy. RESULTS: CE-IOUS assessments were successful in 100% of cases, without any adverse effects. Vascular complications and patient/graft survival rates were identical in the IOUS and CE-IOUS groups (p = 0.65, 0.95 and 0.86, respectively). CE-IOUS confirmed IOUS findings in 93% of cases (n = 96) and led to the realization of an additional procedure (median arcuate ligament lysis) and six conservative strategies despite poor arterial (n = 5) or venous flow (n = 1) under Doppler analysis. The CE+ and CE- groups presented statistically identical perioperative and long-term outcomes. CONCLUSION: This study demonstrated the feasibility of CE-IOUS during whole LT. However, we failed to demonstrate any advantages of CE-IOUS over IOUS. Therefore, IOUS currently remains the gold-standard imaging technique for the intraoperative assessment of vascular patency.
BACKGROUND:Vascular complications following liver transplantation (LT) may result from technical deficiencies. Intraoperative diagnosis remains challenging but can prevent serious delayed complications. Intraoperative Doppler ultrasonography (IOUS) represents the gold standard for imaging, although it requires radiological skills. Contrast-enhanced ultrasonography has been reported during postoperative assessments, but never intraoperatively (CE-IOUS). The aim of this study was to assess the feasibility of routine CE-IOUS, to evaluate its impact on surgical strategy and its usefulness. METHODS: All 553 whole LTs performed in our tertiary centre between 01/2010 and 12/2014 were reviewed. We compared perioperative outcomes and long-term survival in IOUS (n = 370) versus CE-IOUS (n = 103) groups. Secondarily, the seven cases where the two imaging findings conflicted (CE+ Group) were matched 1:2 and compared with an exclusively IOUS procedure (CE- Group, n = 14) to assess the consequences of a specific CE-guided strategy. RESULTS: CE-IOUS assessments were successful in 100% of cases, without any adverse effects. Vascular complications and patient/graft survival rates were identical in the IOUS and CE-IOUS groups (p = 0.65, 0.95 and 0.86, respectively). CE-IOUS confirmed IOUS findings in 93% of cases (n = 96) and led to the realization of an additional procedure (median arcuate ligament lysis) and six conservative strategies despite poor arterial (n = 5) or venous flow (n = 1) under Doppler analysis. The CE+ and CE- groups presented statistically identical perioperative and long-term outcomes. CONCLUSION: This study demonstrated the feasibility of CE-IOUS during whole LT. However, we failed to demonstrate any advantages of CE-IOUS over IOUS. Therefore, IOUS currently remains the gold-standard imaging technique for the intraoperative assessment of vascular patency.
Authors: So Jung Lee; Kyoung Won Kim; So Yeon Kim; Yang Shin Park; Jeongjin Lee; Hyoung Jung Kim; Jong Seok Lee; Gi Won Song; Shin Hwang; Sung-Gyu Lee Journal: J Clin Ultrasound Date: 2013-03-28 Impact factor: 0.910
Authors: Angeles García-Criado; Rosa Gilabert; Luis Bianchi; Ramón Vilana; Marta Burrel; Marta Barrufet; Rafael Oliveira; Juan Carlos García-Valdecasas; Concepción Brú Journal: Eur Radiol Date: 2014-08-12 Impact factor: 5.315
Authors: Parveen Warner; Giuseppe Fusai; Georgios K Glantzounis; Caroline A Sabin; Nancy Rolando; David Patch; Dinesh Sharma; Brian R Davidson; Keith Rolles; Andrew K Burroughs Journal: Transpl Int Date: 2011-01-06 Impact factor: 3.782