Percutaneous Direct Puncture of Retropancreatic Splenic Vein and Portal Thrombectomy in a Patient With Liver Transplantation and Simultaneous Splenectomy

Abstract

Portal vein thrombosis following liver transplantation is generally managed by endovascular treatment. Although several techniques are available for portal venous access, trans-splenic access is of interest because it avoids damage to the liver graft. However, the spleen cannot be punctured to access the portal vein after splenectomy. We herein report a case of portal vein thrombosis following living donor liver transplantation with simultaneous splenectomy successfully treated by percutaneous intervention with direct puncture of the retropancreatic splenic vein. The splenic vein was punctured under computed tomography guidance in the prone position. Portal venography revealed a contrast defect due to a thrombus in the extrahepatic to intrahepatic portal vein. The portal vein was reopened after thrombectomy, and the portal vein thrombosis did not recur for 2 y. The technique and advantages of our approach are described.

Outcomes of living donor liver transplant recipients receiving grafts with the graft-to-recipient weight ratio less than 0.6%: A matched pair analysis

“…In cases with a right lobe graft that contained the inferior right hepatic vein (iRHV), the iRHV was reconstructed when its diameter exceeded 5 mm 21 . As we described, 22,23 splenectomy was indicated when the platelet count at the time of transplantation was < 50,000/µL due to hypersplenism. Because we started to perform splenectomy based on donor age, GV/SLV, and portal venous pressure after graft implantation in April 2021, splenectomy with the intent to modulate the portal inflow was not performed during the study period.…”

Outcomes of liver resection and transarterial chemoembolization in patients with multinodular BCLC-A hepatocellular carcinoma

“…5,6 A few studies have compared overall survival (OS) and recurrence-free survival (RFS) between LR and TACE in patients with multinodular BCLC stage A HCC. 7,8 In a large nationwide cohort study conducted by the Liver Cancer Study Group of Japan, LR was predominantly performed on selected patients with multinodular BCLC stage A HCC and these patients exhibited better survival outcomes compared to those who underwent TACE. 8 However, this study encompassed patients with various tumor characteristics, including macrovascular invasion and HCC beyond the Milan criteria.…”