Successful Endovascular Rescue of a Recurrent Hepatic Artery Graft Thrombosis after Liver Retransplantation

Hepatic artery thrombosis (HAT) is a severe and potentially graft-threatening complication after liver transplantation, associated with biliary ischemia, graft failure, and high mortality. We report the case of a 43-year-old woman with primary sclerosing cholangitis who developed early HAT after orthotopic liver transplantation. An initial endovascular recanalization attempt was unsuccessful, and progressive ischemic cholangiopathy required liver color Doppler with aorto-hepatic arterial reconstruction. During follow-up, recurrent hepatic artery graft thrombosis was detected. Given the high surgical risk, an endovascular approach was undertaken. Successful intraluminal recanalization was achieved using percutaneous transluminal angioplasty and balloon-expandable stent placement, resulting in restoration of hepatic arterial flow. Follow-up imaging confirmed sustained graft patency and preserved liver perfusion. This case highlights the role of timely endovascular intervention as a viable graft-saving option in selected patients with complex post-transplant HAT.