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Role of Imaging in the Management of Splenic Artery Steal Syndrome

Department of Radiology, Section of Abdominal Imaging, Cleveland Clinic Foundation, Cleveland, Ohio USA.

Address correspondence to Shetal N. Shah, MD, Department of Radiology, Section of Abdominal Imaging, Cleveland Clinic Foundation, 9500 Euclid Ave, HB6, Cleveland, OH 44195 USA. E-mail: shahs2{at}ccf.org

Objective. The purpose of this study is to discuss the etiology and role of imaging in the management of splenic artery steal syndrome (SASS) following orthotropic liver transplantation (OLT). Methods. Hepatic arterial thrombosis and stenosis have been the most commonly recognized arterial complications following OLT. Splenic artery steal syndrome is a recently described entity in the transplant literature and thought to be an under-recognized cause of graft ischemia. It is characterized by hepatic arterial hypoperfusion accompanied by splenic arterial and portal venous hyperperfusion and leads to various vascular and biliary graft complications. Because the clinical manifestations of SASS are so non-specific, imaging plays a key role in the diagnosis of this condition. Results. This article discusses the role of imaging in the management of this potentially reversible cause of graft ischemia. Conclusions. Awareness of the imaging features and having a high index of suspicion are essential for the early diagnosis and prompt management of this condition.

Key Words: Doppler sonography • liver transplantation • splenic artery steal syndrome

Abbreviations: OLT, orthotopic liver transplantation • RI, resistive index • SASS, splenic artery steal syndrome