Successful liver transplantation in a patient with a thrombosed portomesenteric system after multiple failed shunts.
Combined portal and mesenteric vein thrombosis preventing restoration of adequate portal venous flow has been considered a contraindication to liver transplantation. We report a patient with failed splenorenal (SR), portocaval (PC), and mesocaval (MC) shunts, who despite the absence of any obvious means for supplying portal venous inflow to a hepatic graft, successfully underwent orthotopic liver transplantation. A method of reconstruction of the portal vein with the use of vein grafts anastomosed to a large splanchnic venous collateral is described. This technique can be used in selected patients in whom orthotopic liver transplantation might otherwise be considered technically impossible.
Castaldo
P
P
Department of Surgery, University of Nebraska School of Medicine, Omaha.
Langnas
A N
AN
Stratta
R J
RJ
Lieberman
R P
RP
Wood
R P
RP
Shaw
B W
BW
D000328:Adult; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000601:surgery; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008642:Mesenteric Veins / Q000000981:diagnostic imaging / Q000601:surgery; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery; D011170:Portasystemic Shunt, Surgical; D011859:Radiography; D013927:Thrombosis / Q000150:complications*