Primary permanent arterialization of the portal vein in liver transplantation.
Permanent total arterialization of the portal vein in liver transplantation has been described as a method of providing portal inflow after insufficient thrombectomy due to chronic occlusion of the portal-vein system. A specific problem is the restriction of the arterial inflow and its long-term adaptation after transplantation. We describe here the surgical techniques and clinical course of three patients who underwent portal-vein arterialization for liver transplantation. Two patients had an uneventful course. In one patient, a flow reduction by means of coil embolization of one arterial inflow branch was performed; thereafter, the patient recuperated well. Analysing the microcirculation of an arterialized graft in comparison with liver grafts with normal non-arterialized portal-vein inflow, we observed an increase in inter-sinusoidal distance and a decrease in sinusoidal red blood cell velocity. From a technical point of view, we recommend permanent portal-vein arterialization by an iliac artery graft interposition from the subdiaphragmatic aorta. The inflow to the portal vein can easily be reduced by the banding of the arterial graft interposition.
Settmacher
Utz
U
Department of Surgery, Charité, Campus Virchow, Humboldt University, Augustenburgerplatz 1, 13353 Berlin, Germany. utz.settmacher@charite.de
Stange
Barbara
B
Schaser
Klaus-Dieter
KD
Puhl
Gero
G
Glanemann
Matthias
M
Steinmüller
Thomas
T
Heise
Michael
M
Neuhaus
Peter
P
D000328:Adult; D000792:Angiography; D001166:Arteriovenous Shunt, Surgical; D001783:Blood Flow Velocity; D004621:Embolization, Therapeutic; D004912:Erythrocytes; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008102:Liver Circulation; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D010690:Phlebography; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery*