Portal vein thrombosis in patients undergoing orthotopic liver transplantation: intraoperative endovascular radiological procedures.
OBJECTIVE
To evaluate the usefulness of endovascular procedures for portal vein complications during orthotopic liver transplantation (OLT).


METHODS
Between May 1994 and November 2004, we performed 504 OLTs in 464 adults. Seventy-eight patients (16.8%) presented with portal vein thrombosis (PVT). This analysis of patients from May 2000 to September 2004 included 10 patients with PVT, who were treated with endovascular techniques due to low portal flow. We compared this group with patients who were treated surgically with attention to rethrombosis and survival rates. If portal vein problems were due to obstruction, a venoplasty and primary stent placement were performed. We also embolized with coils or surgically ligated remaining competitive portosystemic shunts.


RESULTS
Perfusion problems in the allograft were solved in all cases. We placed seven stents and embolized six competitive shunts. One anastomotic dysfunction was repaired. None of the patients died or rethrombosed during surgery or follow-up.


CONCLUSIONS
Endovascular techniques during OLT can resolve some liver graft perfusion problems due to PVT and "steal" phenomena, especially with unsatisfactory eversion thromboendovenectomy in patients with grade IV PVT. Although primary permeability of stents has been good, these results need to be confirmed.
Gómez-Gutierrez
M
M
Liver Transplant Unit, Hospital Juan Canalejo, La Coruña, Spain.
Quintela
J
J
Marini
M
M
Gala
B
B
Suarez
F
F
Cao
I
I
Sellés
C C
CC
Aguirrezabalaga
J
J
Otero
A
A
Mosteiro
S
S
D006801:Humans; D007432:Intraoperative Period; D008104:Liver Cirrhosis, Alcoholic / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D016343:Monitoring, Intraoperative; D011169:Portal Vein / Q000000981:diagnostic imaging* / Q000601:surgery; D011170:Portasystemic Shunt, Surgical; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome