Recanalization of post‐transplant late‐onset long segmental portal vein thrombosis with bidirectional transhepatic and transmesenteric approach

PV complications are the most frequent vascular complications in pediatric LT. We have experienced a case with chronic postoperative PVT that necessitates combined transhepatic and transmesenteric approach and have confirmed mid‐term patency. An eight‐yr‐old boy had successful LDLT with a left later...

Full description

Saved in:
Bibliographic Details
Published in:Pediatric transplantation 2013-03, Vol.17 (2), p.E71-E75
Main Authors: Nosaka, Shunsuka, Isobe, Yoshinori, Kasahara, Mureo, Miyazaki, Osamu, Sakamoto, Seisuke, Uchida, Hajime, Shigeta, Takanobu, Masaki, Hidekazu
Format: Article
Language:English
Subjects:
angioplasty
Child
complications
Endovascular Procedures - instrumentation
Endovascular Procedures - methods
Humans
Liver Transplantation
living‐donor liver transplantation
Male
portal vein
Portal Vein - surgery
Postoperative Complications - diagnosis
Postoperative Complications - surgery
Stents
thrombosis
vascular stent
Venous Thrombosis - diagnosis
Venous Thrombosis - etiology
Venous Thrombosis - surgery
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:PV complications are the most frequent vascular complications in pediatric LT. We have experienced a case with chronic postoperative PVT that necessitates combined transhepatic and transmesenteric approach and have confirmed mid‐term patency. An eight‐yr‐old boy had successful LDLT with a left lateral segment graft at the age of two months for HBV‐related acute liver failure. Seven years after transplantation, the patient suddenly showed a melena with hypovolemic shock. Doppler ultrasound and CT revealed intrahepatic bile duct dilatation and main PVT with collateral formation at hepatic hilus and mesenterium of the Roux‐en‐Y jejunal loop. Urgent splenic artery embolization was performed to control the bleeding and was temporarily effective. Therefore, recanalization of PVO was attempted. Because of long segmental PVO and steep angle between the intrahepatic PV and the portal trunk, bidirectional transhepatic and transmesenteric approach was selected and resulted in deploying three metallic stents necessitating additional infusion thrombolytic therapy. The patient is now followed as an outpatient with patent stents for two yr since the procedure. For the rescue of these patients, recanalization of obstructed PV trunk with bidirectional approach would be feasible with better graft survival and less invasiveness than conventional surgical interventions.
ISSN:1397-3142
1399-3046
DOI:10.1111/petr.12050