Intra-Arterial Contrast-Enhanced Ultrasound for Transcatheter Thrombolysis in Post-Transplant Hepatic Artery Thrombosis: A Preliminary Study

BACKGROUND Hepatic artery thrombosis is the most common and severe vascular complication after liver transplantations. Transcatheter arterial thrombolysis is a viable alternative with high selectivity, low drug dosage, high local drug concentration, and minimal effect on systemic coagulation function. Intra-arterial contrast-enhanced ultrasound (IA-CEUS) is radiation-free and repeatable, can be performed bedside, and could be an alternative for continuous monitoring. We described the efficacy of IA-CEUS in assessing the effect of continuous transcatheter arterial thrombolysis in post-liver transplant hepatic artery thrombosis in a series of cases. MATERIAL AND METHODS Eight patients with diagnosis of hepatic artery thrombosis after liver transplantation between November 2016 and May 2023 were selected. All 8 patients underwent continuous transcatheter arterial thrombolysis, using urokinase. Dynamic IA-CEUS monitoring was performed for each patient during the thrombolysis treatment. Hepatic artery digital subtraction angiography was used to verify the results. RESULTS Two patients showed a hepatic artery perfusion defect. Six patients demonstrated good perfusion of artery. Three patients developed biloma. One patient developed a dissection aneurysm. One patient developed a pseudoaneurysm with catheter displacement in it. One patient developed retroperitoneal hematoma. None of the patients experienced contrast agent-related complications. CONCLUSIONS IA-CEUS was found to be safe and feasible as a new option for evaluating the efficacy of transcatheter arterial thrombolysis in post-liver transplant hepatic artery thrombosis.