0:00

So here are some examples of early changes of liver transplant with an arterial

0:06

stenosis. As we start to look through the Doppler, we can see some mildly

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monophasic hepatic venous waveforms, which are pretty normal in the liver

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transplant setting.

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We don't see that necessarily in all the vessels here. The middle looks normal.

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The left looks a little bit more normal, so it's really only isolated to that right

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side.

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As we get to the intrahepatic arteries, here we have relatively normal to even

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slightly high resistive index in our left hepatic artery.

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So really nothing that would suggest an upstream stenosis exactly.

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Portal veins are nice and patent, and as we scroll through, as we look at the other

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structures, IVC is patent. The right hepatic artery here, again, a little bit

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different in terms of the resistive index, but again, within normal limits here.

0:55

But then when we get to the main hepatic artery, we get a much increased

1:00

velocity, so we're almost 450 centimeters per second, and you can see we see this

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classic wraparound, which we see with aliasing.

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And so aliasing can be seen in a number of different things.

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One of them is stenosis, as in this case was an early case of stenosis, but it can

1:15

be seen in tortuosity as well. You can see when we interrogate this at a slightly

1:20

different spot, the degree of that velocity increase is significantly less.

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So in this case, we didn't see any clear downstream sequelae of a stenosis at this

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juncture with the more normal-looking intrahepatic waveforms.

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But this was a patient who eventually progressed to stenosis.

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But a similar kind of appearance would happen if this patient had tortuosity or if

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potentially if this was really early on, although that velocity is quite elevated.

1:50

This is a companion case to hepatic artery stenosis in a transplant patient.

1:56

When we are looking at this patient's intrahepatic vessels, you can see the right

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hepatic artery here, we have a resistive index that's decreased, so it's 0.38.

2:07

And so we have not very significant differences between the systolic peak and the

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end-diastolic velocity. So this is more of what we would call a tardus parvus

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waveform. As we go through and we look at the other structures, again, this is the

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most distal portion of the main hepatic artery, but the velocity elevation is not

2:28

quite to that significant level just yet.

2:31

As we go through this,

2:34

again, we see monophasic hepatic venous waveforms, kind of normal in a transplant

2:38

setting. And then when we switch over to the left hepatic artery, you can see we do

2:43

see similar, not quite as tardus parvus as the right side, but kind of a similar

2:48

thing with not significant differences between those two, and the resistance index

2:52

is also decreased here. As we further interrogate this patient, we wanted to then

2:57

see, okay, why are we seeing these tardus parvus waveforms?

3:00

And then we would progress, and once we get to the potential area of

3:06

stenosis, then we start to see some aliasing in the hepatic artery.

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We took some closer images, and you can see the waveform is really out of whack

3:14

here, but what you can see is that the velocity is significantly up.

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You can see in that little color area, we have some turbulence, which is

3:21

represented by this aliasing of what we're seeing on the waveform.

3:24

As we start to try to make some adjustments, you can see we're adjusting our

3:27

baseline to kind of correct for the aliasing, and we're seeing that the velocity is

3:32

really around 300 centimeters per second.

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And so there is a little bit of tortuosity here, but this was a patient with true

3:39

stenosis, because we were able to see those velocity elevations here and the distal

3:44

changes where we saw that tardus parvus waveform within the liver.