Hepatic venous stenosis

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  Color Doppler

  
  
  
  
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    May see focal turbulent flow at stenosis and stenotic jet

  
  
  
  
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  Spectral Doppler

  
  
  
  
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    Elevated velocity at site of stenosis or < 10 cm/s away from site of stenosis

    
    
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    Loss of normal triphasic waveform

    
    
    
    
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      Most commonly monophasic in appearance

    
    
    
    
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    May see secondary slow portal vein velocity

  
  
  
  
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  Angiography

  
  
  
  
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    Pressure gradient > 5 mm Hg across stenosis

  
  

Hepatic venous thrombosis

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  Direct visualization of thrombus in hepatic vein (HV) or lack of detectable flow with color, power, or spectral Doppler

HV or inferior vena cava (IVC) stenosis results in outflow obstruction of liver

Immediate posttransplant period: Kinking of vessel

Delayed presentation: Intimal hyperplasia

HV stenosis occurs in < 1% of liver transplants, 2-10% of liver transplants when piggyback technique used

Right lobe liver graft from living donor has higher risk of developing venous congestion because of inadequate venous drainage

Clinical presentation: Lower extremity edema, Budd-Chiari syndrome, ascites

Treatment

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  Stenosis may be treated with balloon-expandable stents or angioplasty

  
  
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  Thrombosis may require surgery or retransplant

Color Doppler box should always include HV and its IVC confluence because stenoses often occur at the junction

Obtain HV spectral Doppler tracings within 3 cm of junction with IVC

If area of aliasing is identified, obtain spectral Doppler with angle correction through the region