Splenic Artery Steal Syndrome with Absent Signal on Color Doppler Ultrasound

Background: Splenic artery steal syndrome (SASS) is a poorly understood and controversial phenomenon which is known to cause hepatic artery (HA) hypoperfusion and may result in graft ischemia in liver transplant recipients. The diagnosis is often suspected on Doppler Ultrasound (DUS).

Case: A 32-year-old female underwent living related liver transplant (LRLT) for hepatitis B-related cirrhosis. The intra op Doppler parameters were: HA-PSV = 32 cm/s, RI = 0.6, Portal Flow = 1.6 L/min. On POD 3 the routine DUS failed to demonstrate any signal in the HA and a diagnosis of HA thrombosis was assumed. CECT was performed which showed absent HA opacification in arterial phase but a faintly opacified HA on delayed venous phase images. DSA was performed and proximal splenic artery embolization (PSAE) was done with coils. Post-PSAE the flow in hepatic artery improved immediately and Doppler parameters were: HA-PSV = 30 cm/s, RI = 0.6, PV Flow (L/min) = 1.3.

Discussion: DUS is the initial test of choice. Generally, HA RI is greater than 0.8; diastolic flow may be reversed and PSV is unusually low (<35 cm/s). Besides, splenic artery diameters >4 mm and/or a splenic artery to hepatic artery diameter ratio >1.5 may be seen.

Publication History

Article published online:
09 February 2023