vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2019-3-76-83vtio-1066Research ArticleКлинические наблюденияClinical CasesСлучай успешной ретрансплантации печени у пациента с ранним тромбозом печеночной артерии, осложненным некрозом желчных протоков, сепсисомA case report of successful liver retransplantation in patient with early hepatic artery thrombosis complicated by bile ducts necrosis and sepsisГрановД. А.GranovD. A.ПоликарповА. А.PolikarpovA. A.ТилеубергеновИ. И.TileubergenovI. I.ЖуйковВ. Н.ZhuikovV. N.

Жуйков Владимир Николаевич. Адрес: 197758, Санкт-Петербург, ул. Ленинградская, 70. Тел. (965) 033-19-34.

Zhuikov Vladimir Nikolaevich. Address: 70, Lenigradskaya str., St. Petersburg, 197758. Теl. (965) 033-19-34.

zhuikov.v@mail.ruМоисеенкоА. В.MoiseenkoA. V.ШералиевА. Р.SheralievA. R.КардановаИ. Г.KardanovaI. G.ФГБУ «Российский научный центр радиологии и хирургических технологий имени академика А.М. Гранова» Минздрава РоссииРоссияA.M. Granov Russian Scientific Center of Radiology and Surgical Technology of the Ministry of Healthcare of the Russian FederationRussian Federation2019300920192137683Copyright © Гранов Д.А., Поликарпов А.А., Тилеубергенов И.И., Жуйков В.Н., Моисеенко А.В., Шералиев А.Р., Карданова И.Г., 20192019Гранов Д.А., Поликарпов А.А., Тилеубергенов И.И., Жуйков В.Н., Моисеенко А.В., Шералиев А.Р., Карданова И.Г.Granov D.A., Polikarpov A.A., Tileubergenov I.I., Zhuikov V.N., Moiseenko A.V., Sheraliev A.R., Kardanova I.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/1066

В представленном случае у пациента во время трансплантации печени после завершения этапа артериальной реконструкции выявлен участок диссекции печеночной артерии (ПА). В течение часа в условиях рентгеноперационной произведено стентирование ПА. В раннем послеоперационном периоде при контрольных ангиографических исследованиях выявлены показания к повторному стентированию ПА, а также эмболизации селезеночной артерии с целью устранения синдрома обкрадывания. Через две недели у пациента развился тромбоз ранее установленных стентов, что потребовало аутовенозного протезирования ПА. Несмотря на все примененные способы реваскуляризации, течение заболевания осложнилось формированием холангиогенных абсцессов, развитием сепсиса. Однако использованные методы эндоваскулярной коррекции сосудистых нарушений в сочетании с проведением своевременной интенсивной и антибактериальной терапии согласно результатам микробиологических исследований позволили сохранить удовлетворительно функционирующий трансплантат. После купирования септических осложнений, стабилизации соматического статуса пациента и нормализации клинико-лабораторных показателей успешно выполнена ретрансплантация печени.

In this present case report during liver transplantation a patient was developed dissection of hepatic artery (HA) which was noticed after arterial reconstruction step. In one hour after surgery at intervention operating room stent placement of HA was performed. At early postoperative period by hepatic angiography study indicated for a second stent placement of HA, also embolization of splenic artery to treat a steal syndrome. After 2 weeks a patient developed thrombosis of recently placed stents which was required vascular reconstruction of HA by using autovenous graft. The condition complicated by development of a cholangiogenous hepatic abscesses and sepsis despite of all used possible methods of liver graft revascularization. However, used methods of vascular correction, which combined of timely carried out intensive care and antibiotic therapy according microbiology laboratory results allows saving graft function. After treatment of septic complications and patient’s somatic status stabilization and normalization of laboratory results liver retransplantation was performed. 

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The authors declare that there are no conflicts of interest present.