New Thrombectomy Technique for Total Portal Vein Thrombosis in Liver Transplantation

Summary

Portal vein thrombosis (PVT) is a frequent complication in patients with portal hypertension resulting from end-stage liver disease. In certain instances, PVT may be a contraindication for liver transplantation. We have developed a novel approach for managing PVT cases involving complete occlusion of the main trunk of the portal vein.

Abstract

Portal vein thrombosis is present in approximately 5-16% of patients with end-stage liver disease who undergo liver transplantation. In this report, we describe a new surgical approach that has been established in our center. Two patients with total thrombosis of the main trunk of the portal vein have been treated currently. Briefly, the portal vein was dissected as caudally as needed to reach an area without thrombus and occlude its cranial portion near the liver. Incision of the portal vein was then performed without cutting the thrombus and by everting the portal vein wall, carefully liberating it from the thrombus until it was removed entirely and remained attached to the native liver. With this new thrombectomy technique, we achieved excellent portal flow in both cases, since the thrombus was not fractured and was entirely removed, leading to optimal reperfusion of the liver graft. Both patients underwent control abdominal CT scans days after the liver transplant, in which no residual thrombi and excellent portal flow in the graft were observed. This novel thrombectomy technique seems safe and feasible, although further experience is necessary to evaluate its long-term outcomes.

Introduction

The portal vein is a crucial structure in the body, transporting approximately 75% of the blood to the liver from the gastrointestinal tract and spleen¹. In patients with advanced liver diseases, portal vein thrombosis may develop, consisting of the formation of clots within the vein, obstructing the blood flow². Portal vein thrombosis (PVT) is a complex complication that poses a significant challenge during liver transplantation³. To ensure optimal graft and patient survival, it is essential to maintain good portal inflow^1,

Protocol

The patients provided written informed consent for the operation and the use of medical data for scientific purposes. This research was performed in compliance with the Declaration of Helsinki and was approved by the local Institution's Human Research Ethics Committee and the Institutional Review Board. For the protocol presentation and explanation, we present two case reports of Grade II PVT that were managed with a novel thrombectomy technique.

1. Preoperative procedure

1. Prohibit the patient from eating and drinking 8 h before the surgery.
2. Use tracheal intubation under general anesthesia. Place a ....

Results

This new thrombectomy technique allowed a complete removal of the thrombus in both cases, resulting in excellent portal flow. An end-to-end portal-portal anastomosis could be performed, achieving quick and homogeneous reperfusion of the graft (Figure 5 and Figure 6). The total operative time was 600 min in Case 1 and 365 min in Case 2, with a transfusion of 3 units of packed red blood cells in each case. As a protocol of our hospital, we perform.......

Discussion

Portal vein thrombosis is a significant and important complication in patients requiring liver transplantation⁷. For cases with a thrombus that occludes the total lumen of the vein, it is often challenging to perform thrombectomy, especially in cases of chronic thrombosis with fibrotic changes in the vessel and thrombus partially or totally adhered to the vessel wall^6,8. Additionally, complications of traditional thrombectomy techniques in.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
SILK 2-0 PRECUTTED	SHALON MEDICAL, USA.	W3410013	Synthetic non-absorbable Suture
PROLENE 5-0	ETHICON, USA.	W8556	Synthetic non-absorbable Suture
VESSEL LOOP	ASPEN SURGICAL PRODUCTS, USA.		Sterile Silicone