Portal vein thrombosis: Evolving techniques to attack this old nemesis portal vein thrombosis in patients undergoing orthotopic liver transplantation: intraoperative endovascular radiological procedures

✍ Scribed by James D. Perkins

• Publisher: John Wiley and Sons
• Year: 2006
• Tongue: English
• Weight: 82 KB
• Volume: 12
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.20842

✦ Synopsis

Purpose: To evaluate the usefulness of endovascular procedures for portal vein complications during orthotopic liver transplantation (OLT). Materials and methods: Between May 1994 and November 2004, we performed 504 OLTs in 464 adults. Seventy-eight patients (16.8%) presented with portal vein thrombosis (PVT). This analysis of patients from May 2000 to September 2004 included 10 patients with PVT, who were treated with endovascular techniques due to low portal flow. We compared this group with patients who were treated surgically with attention to rethrombosis and survival rates. If portal vein problems were due to obstruction, a venoplasty and primary stent placement were performed. We also embolized with coils or surgically ligated remaining competitive portosystemic shunts. Results: Perfusion problems in the allograft were solved in all cases. We placed seven stents and embolized six competitive shunts. One anastomotic dysfunction was repaired. None of the patients died or rethrombosed during surgery or follow-up. Conclusion: Endovascular techniques during OLT can resolve some liver graft perfusion problems due to PVT and "steal" phenomena, especially with unsatisfactory eversion thromboendovenectomy in patients with grade IV PVT. Although primary permeability of stents has been good, these results need to be confirmed.

COMMENTS

Since the early 1990s, portal vein thrombosis (PVT) has ceased to be a contraindication for liver transplantation. 1,2 Continuing progress in diagnostic procedures and surgical techniques has enabled the vast majority of patients with PVT to be transplanted. A study by Gimeno et al. 3 compared 2 homogeneously matched groups of patients undergoing liver transplantation-1 group with PVT and the other group without PVT-and found no significant difference in survival rates between patients with or without PVT.