Bile Duct Alterations After Occlusion of the Hepatic Artery
Arterial occlusion following liver transplantation has been reported to occur in 10%-20% [13, 34, 35] of adults and up to 30%  of children. The clinical signs of hepatic artery occlusion include fulminant graft failure, persistent graft dysfunction, focal parenchymal necroses, and damage to the biliary tree . The only source of blood supply to the biliary tree is hepatic artery. Therefore, biliary damage should always be expected to occur following arterial thrombosis. Bile duct damage leads to leakage, biliary strictures, and finally to biliary sepsis [12, 39]. In exceptional cases, hepatic artery occlusion may remain asymptomatic. The radiologic features of ischemic-type lesions resemble those of biliary destruction following arterial thrombosis. Any radiological demonstration of multiple strictures therefore requires angiography. Leaks may occur at the site of anastomosis but also in any other portion of the biliary tree including the intrahepatic ducts. Strictures are numerous, and necrotic material from the ductal wall and debris from the superimposed infections form sludge and casts within the biliary system. In those rare cases in which bile duct destruction is limited and restricted mainly to the extrahepatic ducts, surgical repair by a hilar anastomosis may be feasible. This is particularly in the case in children. In the overwhelming majority of patients retransplantation is required. For palliation, ischemic biliary lesions may be managed by a percutaneous or endoscopic approach.
KeywordsCatheter Hepatitis Ischemia Sludge Corticosteroid
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