No-touch hepatic hilum technique to treat early portal vein thrombosis after pediatric liver transplantation.
A 'no-touch' hilum technique used to treat early portal vein complications post-liver transplantation in five children with body weight <10 kg is described. Four patients developed thrombosis and one portal flow absence secondary to collateral steal flow. A vascular sheath was placed through the previous laparotomy in the ileocolic vein (n = 2), inferior mesenteric vein (n = 1) or graft umbilical vein (n = 1). Portal clots were mechanically fragmented with balloon angioplasty. In addition, coil embolization of competitive collaterals (n = 3) and stent placement (n = 1) were performed. The catheter was left in place and exteriorized through the wound (n = 2) or a different transabdominal wall puncture (n = 3). A continuous transcatheter perfusion of heparin was subsequently administered. One patient developed recurrent thrombosis 24 h later which was resolved with the same technique. Catheters were removed surgically after a mean of 10.6 days. All patients presented portal vein patency at the end of follow-up. Three patients are alive after 5 months, 1.5 and 3.5 years, respectively; one patient required retransplantation 18 days postprocedure and the remaining patient died of adenovirus infection 2 months postprocedure. In conclusion, treatment of early portal vein complications following pediatric liver transplantation with this novel technique is feasible and effective.
Bueno
J
J
Pediatric Liver Transplantation Unit, Hospital Universitario Valle de Hebron, Autonomous University of Barcelona, Barcelona, Spain. jbueno@vhebron.net
Perez-Lafuente
M
M
Venturi
C
C
Segarra
A
A
Barber
I
I
Molino
J A
JA
Romero
A
A
Ortega
J
J
Bilbao
I
I
Martinez-Ibañez
V
V
Charco
R
R
D000257:Adenoviridae Infections / Q000209:etiology / Q000401:mortality; D000293:Adolescent; D000792:Angiography; D000800:Angioplasty, Balloon; D002648:Child; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D011169:Portal Vein / Q000503:physiopathology; D011182:Postoperative Care; D015642:Radiology, Interventional; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*