Eversion thromboendovenectomy for organized portal vein thrombosis encountered during liver transplantation

• Published in: Transplantation proceedings 2003-08, Vol.35 (5), p.1915-1917
• Main Authors: Robles, R, Fernández, J.A, Hernández, Q, Marin, C, Ramirez, P, Sánchez Bueno, F, Luján, J.A, Rodriguez, J.M, Acosta, F, Parrilla, P
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Humans; Intraoperative Complications - surgery; Liver Cirrhosis - complications; Liver Cirrhosis - surgery; Liver Transplantation - adverse effects; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Mesenteric Veins - surgery; Middle Aged; Portal Vein - surgery; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Thrombosis - surgery; Treatment Outcome
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/S0041-1345(03)00599-2

Due to the technical experience acquired in the field of liver transplantation portal vein thrombosis is no longer considered a contraindication for transplantation. Nevertheless, the results obtained in patients with portal vein thrombosis are at times suboptimal, and there is no consensus on the appropriate surgical technique. Among the 455 liver transplants performed between May 1988 and December 2001, 32 (7%) presented with portal vein thrombosis. Twenty (62%) were type Ib, seven (22%) type II/III, and five (16%) type IV. Twenty-two were men (69%), with a mean age of 50 years (range: 30–70 years); the thrombosis in all cases developed in a cirrhotic liver. The surgical method in all cases consisted of an eversion thromboendovenectomy under direct visual guidance, with occlusion of the portal flow using a Fogarty balloon. Among the 32 cases undergoing thrombectomy, 31 (96%) were successful with a failure in a case of type IV thrombosis, which was resolved by portal arterialization. Of the 31 successful cases, only one with type IV thrombosis rethrombosed. The 5-year survival rate of the patients in the series was 69%. Only two patients died from causes related to the thrombosis, both showing type IV thrombosis. The ideal treatment for portal thrombosis during liver transplantation depends on its extension and on the experience of the surgeon. In our experience, eversion thromboendovenectomy resolves most thromboses (types I, II, and III), but management of type IV, which occasionally can be treated with this technique, may require more complex procedures such as bypass, portal arterialization or cavoportal hemitransposition.