Post Liver Transplant Inferior Vena Cava Stenosis Management with Gianturco Z Stents

Purpose: Stenosis of the inferior vena cava (IVC), although rare, is a serious complication affecting recipients of liver transplants. Patients with IVC stenosis may experience lower extremity edema, dyspnea, ascites, portal hypertension, and most concerning, liver graft failure and death. This complication is related to surgical technique at the caval anastomosis and is caused by hematoma, mismatch between the donor and recipient vasculature, or kinking of the anastomosis. We aim to present the effectiveness and follow-up of two patients with IVC stenosis after liver transplant managed with Gianturco Z stents.

Materials and Methods: Two patients with a history of orthotopic liver transplant with lower extremity edema and elevated liver function enzymes presented with venography and intravascular ultrasonography (IVUS) z imaging demonstrating severe suprahepatic IVC anastomotic stenosis. The two patients underwent endovascular venous intervention and suprahepatic IVC Gianturco Z stent placement. Technical success and effectiveness, complications, and clinical follow-up were recorded and reviewed.

Results: Endovascular treatment with percutaneous venous access, with or without venous thrombectomy/thrombolysis, IVUS evaluation, with or without venous pressure gradient measurements, balloon venoplasty, and suprahepatic IVC Gianturco Z stent placement were performed. Both patients were started on dual antiplatelet therapy after their procedures. Technical success with restoration of venous flow, decrease in pressure gradient measurements, and venogram and IVUS demonstrating improved patency without stenosis was achieved in both patients. Stent patency during follow-up was also present in both patients. Clinical success defined as resolution of IVC stenosis related symptoms, and significant improvement of liver function enzymes was also achieved in both patients and documented during follow-up. In both patients, there were no peri- or postprocedure minor or major complications.

Conclusions: Gianturco Z stent placement for the management of IVC anastomotic stenosis after liver transplant is an effective and durable procedure. Stenting relieved stenosis in both patients and showed long-term patency.