A bidirectional approach for portal vein stent placement in a child with complete portal vein occlusion after living donor liver transplantation

Abstract

Delayed PV complications are not rare in pediatric liver transplantation. Although PTPV offers a treatment and minimizes surgical revision, in case of complete PV thrombosis (PVT), the failure rate of PTPV is high. Herein, we report a successful technique of PTPV in a case of complete PVT with a stent placement using a bidirectional approach in a child with living donor liver transplantation.

Combined Transhepatic and Transsplenic Recanalization of Chronic Portal Vein Occlusion to Treat Jejunal Varices: A Report of Two Cases

“…However, the transmesenteric approach requires a laparotomy and is more invasive than percutaneous approaches. There have been several reports of pediatric PVR with a combined transsplenic and hepatic approach [7,8]. In our case, a combined percutaneous transhepatic and transsplenic approach was undertaken effectively in adult patients.…”

Recanalization of Chronic Extrahepatic Portal Vein Obstruction in Pediatric Patients Using a Minilaparotomy Approach

“…Post-procedural bleeding, particularly in patients requiring anticoagulation for stent placement or a pre-existing prothrombotic state, is a significant concern for the transplenic or transhepatic approach (17). In addition, the TIPS-like (transjugular intrahepatic portosystemic shunt) and transhepatic approaches may be stymied by technical issues that make it difficult to find and follow the correct ''pathway'' through the occluded portal vein (18).…”

Intraoperative portal vein stenting through umbilical vein approach: An innovative salvage procedure for portal vein thrombosis in pediatric liver transplant

“…These patients usually present with portal flow diversion through spontaneously developed porto‐systemic shunts. This along with other factors may contribute to a higher incidence of postoperative PVT include extrinsic compression on PV from enlarged lymph nodes at porta hepatis, large size of graft (relative to subphrenic recess), small abdominal volume, technical factors such as twisting or kinking of PV, unavoidable difference in diameter between donor and recipient PVs, and tension on PV anastomosis 1 . The treatment of peri‐operative PVT following pediatric living donor liver transplantation is a challenge.…”

“…The importance of the intraoperative intraluminal portal vein stenting was described in numerous studies 2–4 . There are several approaches described in literature for PVS: inferior mesenteric vein (IMV) approach, 5 segment 4 PV (P4) approach, 6 bilateral approach, 1 ileocolic vein approach, 7 percutaneous transhepatic approach 8 and transjugular approach 9 . Most of the approaches described in the literature for intraoperative PVS do not leave any possibility of easy access for postoperative maneuverability in case of a recurrence of thrombosis.…”

“…This along with other factors may contribute to a higher incidence of postoperative PVT include extrinsic compression on PV from enlarged lymph nodes at porta hepatis, large size of graft (relative to subphrenic recess), small abdominal volume, technical factors such as twisting or kinking of PV, unavoidable difference in diameter between donor and recipient PVs, and tension on PV anastomosis. 1 The treatment of peri-operative PVT following pediatric living donor liver transplantation is a challenge. In the intraoperative period, it is essential to establish portal inflow and in case of denovo thrombosis or recurrence of thrombosis in the early postoperative period, it is essential to do a timely thrombolysis to salvage the graft.…”