Splenic infarction after splenorenal arterial bypass

Valentine, R. James; Rossi, Matthew B.; Myers, Stuart I.; Clagett, G. Patrick

doi:10.1016/0741-5214(93)90162-f

Cited by 14 publications

(5 citation statements)

References 12 publications

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“…10 The potential complication of splenic infarction may be prevented by ligation of the artery proximally away from the splenic hilum. 11 Compared with the technique of diversion of superior mesenteric venous flow by mesocaval shunt with downstream ligation of the superior mesenteric vein, 12 splenic artery ligation is a technically simpler procedure that easily can be added to a complicated transplant operation.…”

Section: Discussionmentioning

confidence: 99%

Portal hyperperfusion injury as the cause of primary nonfunction in a small-for-size liver graft-successful treatment with splenic artery ligation

2003

Liver Transplantation

137

124

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Dysfunction of a small-for-size graft is an important clinical problem after living donor liver transplantation in adults. We report a case of primary nonfunction after a small-for-size right lobe living donor liver transplant that was successfully salvaged by reduction of portal pressure and blood flow after splenic artery ligation. The case established portal hyperperfusion injury as a cause of primary nonfunction in a small-for-size graft and we recommend that portal pressure be measured when clinical suspicion arises. Splenic artery ligation is a technically simple procedure that can be applied for the prevention or treatment of such injury. (Liver Transpl 2003;9:626-628.) P rimary nonfunction (PNF) is uncommon after living donor liver transplantation (LDLT). 1 The various adverse factors in a brain-dead donor that may contribute to the development of PNF 2 do not exist in a healthy living donor. However, with the increasing practice of adult-to-adult LDLT, dysfunction of a small-for-size graft or small-for-size syndrome has emerged as an important clinical problem. A small-forsize graft may sustain a significant degree of injury that results from portal hyperperfusion. 3 In this article, we reported a patient who developed clinical evidence of PNF after a small-for-size right lobe LDLT. The PNF was attributed to severe portal hyperperfusion injury, and it was treated successfully by reduction of portal pressure after splenic artery ligation. Case ReportA 41-year-old man with chronic hepatitis B virus (HBV) infection-related cirrhosis developed progressive jaundice, intractable ascites, and repeated episodes of spontaneous bacterial peritonitis. He had developed lamivudine-resistant HBV mutant before he was referred for consideration of liver transplantation. Sequencing of the YMDD (tyrosine, methionine, and aspartic acid) locus of the HBV-DNA in serum revealed a YIDD (tyrosine, isoleucine, and aspartic acid) mutant. His serum total bilirubin was 518 mol/L, and his serum creatinine was 153 mol/L. The serum albumin was 28 g/L and international normalized ratio 4.4. The Child-Pugh score was 12 and the MELD score was 41. His body weight was 72 kg and he was 1.7 m tall. The standard liver weight according to the Urata's formula 4 was 1,296 g. The donor was the patient's wife, who was a 38-year-old woman with good past health and no history of alcohol intake. She was 1.54 m tall and weighed 57 kg. Preoperative computed tomography (CT) scan showed normal liver anatomy with no evidence of fatty change, and volumetric study estimated that the right lobe volume was 754 mL.LDLT using a right lobe graft with the middle hepatic vein was performed using a technique that was modified recently. 5 Prophylaxis against recurrent hepatitis B was carried out with a combination of adefovir and intravenous hepatitis B immune globulin. In the donor operation, the parenchymal transection was performed with an ultrasonic dissector without any vascular inflow or outflow occlusion, and there was no warm ischemia. The graft was flushed...

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Section: Discussionmentioning

confidence: 99%

Portal hyperperfusion injury as the cause of primary nonfunction in a small-for-size liver graft-successful treatment with splenic artery ligation

2003

Liver Transplantation

137

124

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“…They suggested that the existing collateral circulation may not always sustain splenic viability. 6 The possibility of a steal phenomenon, resulting in either splenic or renal infarction, was of particular concern in our patient given that the spleen already was fully mobilized from its collateral circulation. To maximize the success of our revascularization, we elected to perform a splenectomy in this patient before constructing the anastomosis.…”

Section: Discussionmentioning

confidence: 84%

Splenorenal Arterial Bypass: Description of Technique and Case Example in an Instance of Renal Revascularization during Adrenalectomy for Adrenocortical Carcinoma

Yozawitz¹,

Kissin²,

Szuchmacher³

et al. 2015

Int J Angiol

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We present a patient with a 16 cm adrenocortical carcinoma that underwent a left adrenalectomy en bloc with resection of the involved segment of the left renal artery. A splenectomy and splenorenal bypass was performed to revascularize the left kidney. To our knowledge, this is the first instance in the literature of a splenorenal arterial bypass being reported for renal revascularization during an extirpative oncologic procedure. A 64-year-old male patient, with history significant for adrenocortical carcinoma, status post prior right adrenalectomy with partial right nephrectomy, presented for an elective left adrenalectomy. Preoperative work-up revealed an 11.4 × 13.2 × 16 cm left adrenal mass, most consistent with an adrenocortical carcinoma. At the time of surgery, the mass was found to be intimately adherent to the aorta at the takeoff of the left renal artery. Moreover, the left renal artery appeared to be coursing directly through the mass. The involved segment of the left renal artery was resected en bloc with the tumor. Because of concerns for a small and likely poorly functioning right renal remnant, a decision was made to attempt to salvage the left kidney. This was accomplished by performing a splenectomy and constructing a splenorenal bypass. Serial Duplex Doppler renal ultrasound studies were obtained over the first three postoperative days and demonstrated improved arterial waveforms. Serum creatinine reached a peak level of 3.76 mg/dL on postoperative day 3, and then began to slowly trend down to 3.37 mg/dL on the day of discharge (postoperative day7).

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“…One of the most important aspects of our study is to draw attention to splenic abscesses or acute pancreatitis that may develop after SAT. Although splenic infarction following SpA ligation (4) or SpA interventions (5) has been described previously, the potential devastating consequences, such as splenic abscess, have been overlooked to date.…”

Section: Discussionmentioning

confidence: 99%

Splenic Artery Transposition for Hepatic Artery Reconstruction During Liver Transplantation: Is It the Best Choice for Adequate Arterial Inflow in Extraordinary Conditions?

et al. 2021

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Obtaining partial allografts and performing arterial reconstruction in living donor liver transplantation (LDLT) is technically demanding. The risk of hepatic artery thrombosis (HAT) remains high in LDLT due to the small caliber of the arteries. The graft and the recipient hepatic artery (HA) cannot be directly anastomosed in certain patients due to a narrow diameter or a short graft HA. For such patients, the recipient splenic artery (SpA) can be used for hepatic arterial supply, which is known as the splenic artery transposition (SAT) graft. This procedure is termed extraanatomical hepatic artery reconstruction (HAR).

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Splenic infarction after splenorenal arterial bypass

Cited by 14 publications

References 12 publications

Portal hyperperfusion injury as the cause of primary nonfunction in a small-for-size liver graft-successful treatment with splenic artery ligation

Portal hyperperfusion injury as the cause of primary nonfunction in a small-for-size liver graft-successful treatment with splenic artery ligation

Splenorenal Arterial Bypass: Description of Technique and Case Example in an Instance of Renal Revascularization during Adrenalectomy for Adrenocortical Carcinoma

Splenic Artery Transposition for Hepatic Artery Reconstruction During Liver Transplantation: Is It the Best Choice for Adequate Arterial Inflow in Extraordinary Conditions?

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