Endovascular Treatment of Splenomesenteric–Portal Vein Thromboses during Orthotopic Liver Transplantation

Marini, Milagros; Gómez-Gutiérrez, Manuel; Cao, Ignacio; Selles, C.; Aguirrezabalaga, J.; Otero, Alejandra; Soler, Rafaela

doi:10.1097/01.rvi.0000167851.00221.b0

Cited by 14 publications

(5 citation statements)

References 24 publications

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“…Better patient selection and the use of the renoportal hemitransposition have demonstrated long‐term survival 18, 19. Recently, endovascular techniques during LTx have shown their value in solving some liver graft perfusion problems in patients with PVT grades 3 or 4 20, 21.…”

Section: Discussionmentioning

confidence: 99%

Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome

Lendoire

Raffin

Cejas

et al. 2007

HPB

100

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Section: Discussionmentioning

confidence: 99%

Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome

Lendoire

Raffin

Cejas

et al. 2007

HPB

100

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“…A large SSRS may require percutaneous embolization preoperatively, ligation at its transition point into the LRV intraoperatively, or ligation of the LRV at its transition into the inferior vena cava intraoperatively. [2][3][4]7,8,12,13 A severely atrophic or thrombosed portal vein may require reconstitution via a left renoportal interposition vein graft instead of the usual portal vein-to-portal vein anastomosis. 14 Although there are no accepted absolute criteria for prophylactic ligation of portosystemic varices during liver transplantation, a few recent surgical studies attempt to address this issue.…”

Section: Discussionmentioning

confidence: 99%

Vascular Steal of the Portal Vein After Orthotopic Liver Transplant

Horrow

Phares

Viswanadhan

et al. 2010

Journal of Ultrasound in Medicine

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Spontaneous splenorenal shunts (SSRSs) are portosystemic connections between the splenic vein and the left renal vein (LRV) that develop commonly in patients with portal hypertension. (1) They reportedly occur in 18% to 19% of patients evaluated for a liver transplant. (2),(3) As the liver become more cirrhotic, a major steal phenomenon may occur, whereby blood is shunted from the high-resistance venous bed of the liver to the lower systemic pressure of the LRV. (4) Not infrequently, an SSRS will go undetected during orthotopic liver transplantation because dissection is limited to the right upper quadrant. The importance of these shunts may be underappreciated preoperatively by the radiologist. Usually, if small, these shunts will involute without incident when the lower-resistance allograft is implanted. (5),(6) Larger varices, those greater than 10 mm at the level of transition into the LRV, are more likely to steal blood from the liver, causing allograft failure and possibly death. (4),(7),(8) It is therefore important to document on preoperative imaging the size and location of portosystemic varices in any patient being evaluated for liver transplantation. We present a case in which intraoperative sonography showed a large SSRS that impaired hepatic portal inflow after transplantation, ultimately resulting in the patient's death.

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“…A number of endovascular procedures for the treatment of MVT have been developed in recent years, including percutaneous transjugular intrahepatic portosystemic shunting (TIPS) with mechanical aspiration thrombectomy and direct thrombolysis, percutaneous transhepatic mechanical thrombectomy (for case report see Appendix S1 , supporting information), percutaneous transhepatic thrombolysis, thrombolysis via the SMA, and thrombolysis via a surgically placed mesenteric vein catheter. Rapid thrombus removal or dissolution can be achieved by these techniques, especially after TIPS and stent placement to create a low‐pressure run‐off. Mechanical thrombectomy is performed using a variety of thrombectomy devices and is most effective in cases of acute rather than chronic thrombus.…”

Section: Treatment Of Mesenteric Venous Thrombosismentioning

confidence: 99%

Modern treatment of acute mesenteric ischaemia

Acosta

Björck

2013

British Journal of Surgery

160

118

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Background: Diagnosis of acute mesenteric ischaemia in the early stages is now possible with modern computed tomography (CT), using intravenous contrast enhancement and imaging in the arterial and/or portal venous phase. The availability of CT around the clock means that more patients with acute mesenteric ischaemia may be treated with urgent intestinal revascularization.Methods: This was a review of modern treatment strategies for acute mesenteric ischaemia. Results: Endovascular therapy has become an important alternative, especially in patients with acute thrombotic superior mesenteric artery (SMA) occlusion, where the occlusive lesion can be recanalized either antegradely from the femoral or brachial artery, or retrogradely from an exposed SMA after laparotomy, and stented. Aspiration embolectomy, thrombolysis and open surgical embolectomy, followed by on-table angiography, are the treatment options for embolic SMA occlusion. Endovascular therapy may be an option in the few patients with mesenteric venous thrombosis who do not respond to anticoagulation therapy. Laparotomy is needed to evaluate the extent and severity of visceral organ ischaemia, which is treated according to the principles of damage control surgery. Conclusion:Modern treatment of acute mesenteric ischaemia involves a specialized approach that considers surgical and, increasingly, endovascular options for best outcomes.

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Endovascular Treatment of Splenomesenteric–Portal Vein Thromboses during Orthotopic Liver Transplantation

Cited by 14 publications

References 24 publications

Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome

Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome

Vascular Steal of the Portal Vein After Orthotopic Liver Transplant

Modern treatment of acute mesenteric ischaemia

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