Ischemic cholangiopathy is focal damage to the biliary tree due to disrupted flow from the hepatic artery via the peribiliary arterial plexus.
(See also Overview of Vascular Disorders of the Liver.)
Etiology of Ischemic Cholangiopathy
Common causes of ischemic cholangiopathy include
Vascular injury during orthotopic liver transplantation or laparoscopic cholecystectomy
Graft-rejection injury
Chemoembolization
Radiation therapy
Thrombosis resulting from hypercoagulability disorders
Bile duct injury (ischemic necrosis) results, causing cholestasis, cholangitis, or biliary strictures (often multiple). Ischemic cholangiopathy most commonly occurs in people who have had a liver transplant.
Symptoms and Signs of Ischemic Cholangiopathy
Symptoms (eg, pruritus, dark urine, pale stools) and results of laboratory tests and imaging studies may indicate cholestasis.
Diagnosis of Ischemic Cholangiopathy
Magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography (ERCP), or both
The diagnosis is suspected when cholestasis is evident in patients at risk, particularly after liver transplantation. Ultrasonography is the first-line diagnostic imaging test for cholestasis, but most patients require magnetic resonance cholangiopancreatography, ERCP, or both to rule out other causes such as cholelithiasis or cholangiocarcinoma (see Imaging Tests of the Liver and Gallbladder).
Treatment of Ischemic Cholangiopathy
For rejection, antirejection therapy and possibly retransplantation
For biliary strictures, balloon dilation and stenting
Treatment is directed at the cause. After liver transplantation, such treatment includes antirejection therapy and possible retransplantation. Biliary strictures warrant endoscopic balloon dilation and stenting.
