Arterial steal syndrom in patients after liver transplantation: transarterial embolization of the splenic and gastroduodenal arteries.

Purpose: To evaluate transarterial embolization of splenohepatic and gastro duodenal steal syndrome in patients with impaired liver function tests afte r liver transplantation. Methods and Material: In a prospective study 22 pa tients (10 male, 12 female; mean age 49.5 years) with unexplained elevation of hepatic enzymes after liver transplantation underwent transcatheter art erial embolization of splenohepatic (n=18) and gastroduodenal (n=4) steal d rome with use of Gianturco coils or microcoils. Liver and spleen parenchyma were surveyed and evaluated before and after embolization with plain helic al CT, including volumetry of liver and spleen. Results: DSA examinations r evealed a dilated splenic artery (n=18) or gastroduodenal artery (n=4) comb ined with a slightly decreased perfusion of the hepatic arteries, while imm ediately after successful embolization a normal perfusion of the hepatic ar teries could be noted. Volumetric measurements before and after embolizatio n showed no significant changes in liver parenchyma (x = + 7% +/- 2), and v ariable changes in splenic volume of -5% to + 28% (mean, + 11%), with initi al measurements. Clinical follow-up examinations revealed a normalization o f the previously elevated hepatic enzymes and a normalization of liver func tion tests after successful embolization. Complications were observed in 4 patients (infarction of the spleen). Conclusions: The preliminary results r eveal that in liver transplant candidates with splenohepatic and gastroduod enal steal syndrome successful embolization results in an improvement of or gan perfusion with normalization of function tests.