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Hepatic Vein Stenosis after Living Donor Liver Transplantation: Evaluation with Doppler US¹

¹ From the Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388–1 Poongnap-dong, Seoul 138–736, Korea. Received June 10, 2002; revision requested August 20; final revision received May 5, 2003; accepted May 6. Address correspondence to T.K.K. (e-mail: tkkim@amc.seoul.kr).

View larger version (93K): [in a new window]   Figure 1. Transverse oblique duplex Doppler US image shows triphasic wave pattern of the hepatic vein in a 61-year-old man without hepatic vein stenosis after LDLT. Two antegrade peaks are separated by a short phase of retrograde flow (v), and a period of reversed flow (a) follows at the of the second antegrade flow.

View larger version (164K): [in a new window]   Figure 2. Sagittal oblique duplex Doppler US image shows monophasic wave pattern of the hepatic vein in a 49-year-old man with hepatic vein stenosis after LDLT.

View larger version (114K): [in a new window]   Figure 3. Transverse oblique duplex Doppler US image shows biphasic wave pattern of the hepatic vein in a 40-year-old woman without hepatic vein stenosis after LDLT.

View larger version (137K): [in a new window]   Figure 4a. Monophasic wave pattern in a 42-year-old man with hepatic vein stenosis after LDLT. (a) Sagittal oblique duplex Doppler US image shows monophasic wave pattern of the hepatic vein. (b, c) Images obtained at hepatic venography. (b) Luminal narrowing (arrow) is seen at the anastomotic site of the hepatic veins. The pressure gradient between the hepatic vein and IVC is 12 mm Hg. (c) After stent insertion (arrowheads), the narrowed segment of the hepatic vein has disappeared, and the pressure gradient is 1 mm Hg. (d) Sagittal oblique duplex Doppler US image obtained after stent placement into the hepatic vein shows a triphasic wave pattern.

View larger version (110K): [in a new window]   Figure 4b. Monophasic wave pattern in a 42-year-old man with hepatic vein stenosis after LDLT. (a) Sagittal oblique duplex Doppler US image shows monophasic wave pattern of the hepatic vein. (b, c) Images obtained at hepatic venography. (b) Luminal narrowing (arrow) is seen at the anastomotic site of the hepatic veins. The pressure gradient between the hepatic vein and IVC is 12 mm Hg. (c) After stent insertion (arrowheads), the narrowed segment of the hepatic vein has disappeared, and the pressure gradient is 1 mm Hg. (d) Sagittal oblique duplex Doppler US image obtained after stent placement into the hepatic vein shows a triphasic wave pattern.

View larger version (92K): [in a new window]   Figure 4c. Monophasic wave pattern in a 42-year-old man with hepatic vein stenosis after LDLT. (a) Sagittal oblique duplex Doppler US image shows monophasic wave pattern of the hepatic vein. (b, c) Images obtained at hepatic venography. (b) Luminal narrowing (arrow) is seen at the anastomotic site of the hepatic veins. The pressure gradient between the hepatic vein and IVC is 12 mm Hg. (c) After stent insertion (arrowheads), the narrowed segment of the hepatic vein has disappeared, and the pressure gradient is 1 mm Hg. (d) Sagittal oblique duplex Doppler US image obtained after stent placement into the hepatic vein shows a triphasic wave pattern.

View larger version (134K): [in a new window]   Figure 4d. Monophasic wave pattern in a 42-year-old man with hepatic vein stenosis after LDLT. (a) Sagittal oblique duplex Doppler US image shows monophasic wave pattern of the hepatic vein. (b, c) Images obtained at hepatic venography. (b) Luminal narrowing (arrow) is seen at the anastomotic site of the hepatic veins. The pressure gradient between the hepatic vein and IVC is 12 mm Hg. (c) After stent insertion (arrowheads), the narrowed segment of the hepatic vein has disappeared, and the pressure gradient is 1 mm Hg. (d) Sagittal oblique duplex Doppler US image obtained after stent placement into the hepatic vein shows a triphasic wave pattern.