Donor iliac vein interposition during liver transplantation in a patient with a migrated transjugular intrahepatic portosystemic shunt.
BACKGROUND
Transjugular intrahepatic portosystemic shunts (TIPS) are sometimes used to reduce the risk of variceal bleeding or treat intractable ascites before orthotopic liver transplantation (OLT). TIPS usually do not make OLT more difficult, but rarely, malposition of TIPS can significantly complicate OLT.


RESULTS
The following report describes a patient in whom an initially well-placed Wallstent migrated to the confluence of the splenic and superior mesenteric veins. During liver transplantation, the portal vein containing the Wallstent was completely resected, and the portal vein was reconstructed with donor iliac vein. After sewing the iliac vein onto the portal remnant, the liver transplant was completed under portosystemic bypass. The patient had an uneventful recovery.


CONCLUSIONS
Wallstents can migrate within the portal vein. An interposition graft of donor vein allows full resection of the portal vein containing a migrated stent and facilitates portosystemic bypass and portal anastomosis.
Farney
A C
AC
Department of Surgery, University of Minnesota Medical School, Minneapolis, 55455, USA.
Gamboa
P
P
Payne
W D
WD
Gruessner
R W
RW
D005548:Foreign-Body Migration; D006801:Humans; D007084:Iliac Vein / Q000601:surgery*; D008104:Liver Cirrhosis, Alcoholic / Q000601:surgery; D008108:Liver Diseases, Alcoholic / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011183:Postoperative Complications; D015607:Stents