Portal vein obstruction after liver transplantation in children treated by simultaneous minilaparotomy and transhepatic approaches: initial experience.
Portal vein thrombosis is a complication that occurs anytime after liver transplantation and can compromise the patient and graft survival. We describe a combined technique for PV recanalization in cases of PV obstruction after liver transplantation. Four children (1%), of 367 subjected to liver transplantation from June 1991 to December 2008, underwent PV recanalization through a combined approach (transhepatic and minilaparotomy). All children received left lateral hepatic segments, developed Portal vein thrombosis (n=3) and stenosis (n=1), and presented with symptoms of portal hypertension after transplantation. PV recanalization was tried by transhepatic retrograde access, and a minilaparotomy was performed when percutaneous recanalization was unsuccessful. Three patients underwent a successful portal recanalization and stent placement with the combined technique. In one patient, the recanalization was unsuccessful because of an extensive portomesenteric thrombosis. The other three children had the portal flow reestablished and followed with Doppler US studies. They received oral anticoagulation for three consecutive months after the procedure and the clinical symptoms subsided. In case of PV obstruction, the combined approach is technically feasible with good clinical and hemodynamic results. It' is a minimally invasive procedure and can be tried to avoid or delay surgical treatment or retransplantation.
Interventional Radiology Unit, Sírio Libanês Hospital/A. C. Camargo Hospital, São Paulo, SP, Brazil. fcarnevale@uol.com.br
Francisco C
FC
Carnevale
Aline C B
AC
Santos
João
J
Seda-Neto
Charles E
CE
Zurstrassen
Airton M
AM
Moreira
Eduardo
E
Carone
Antonio S Z
AS
Marcelino
Gilda
G
Porta
Renata
R
Pugliese
Irene
I
Miura
Vera D
VD
Baggio
Teresa
T
Guimarães
Giovanni G
GG
Cerri
Paulo
P
Chapchap
D000284:Administration, Oral; D017130:Angioplasty / Q000379:methods*; D000925:Anticoagulants / Q000627:therapeutic use; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000150:complications*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007813:Laparotomy / Q000379:methods*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D011169:Portal Vein / Q000503:physiopathology*; D013927:Thrombosis / Q000150:complications*; D018608:Ultrasonography, Doppler / Q000379:methods
D000925:Anticoagulants; D007166:Immunosuppressive Agents