title: Recanalization of post-transplant late-onset long segmental portal vein thrombosis with bidirectional transhepatic and transmesenteric approach.
abstract: PV complications are the most frequent vascular complications in pediatric LT. We have experienced a case with chronic postoperative PVT that necessitates combined transhepatic and transmesenteric approach and have confirmed mid-term patency. An eight-yr-old boy had successful LDLT with a left lateral segment graft at the age of two months for HBV-related acute liver failure. Seven years after transplantation, the patient suddenly showed a melena with hypovolemic shock. Doppler ultrasound and CT revealed intrahepatic bile duct dilatation and main PVT with collateral formation at hepatic hilus and mesenterium of the Roux-en-Y jejunal loop. Urgent splenic artery embolization was performed to control the bleeding and was temporarily effective. Therefore, recanalization of PVO was attempted. Because of long segmental PVO and steep angle between the intrahepatic PV and the portal trunk, bidirectional transhepatic and transmesenteric approach was selected and resulted in deploying three metallic stents necessitating additional infusion thrombolytic therapy. The patient is now followed as an outpatient with patent stents for two yr since the procedure. For the rescue of these patients, recanalization of obstructed PV trunk with bidirectional approach would be feasible with better graft survival and less invasiveness than conventional surgical interventions.
authors: Department of Radiology, National Center for Child Health and Development, Tokyo, Japan. nosaka-s@ncchd.go.jp
authors: Shunsuka
authors: S
authors: Nosaka
authors: Yoshinori
authors: Y
authors: Isobe
authors: Mureo
authors: M
authors: Kasahara
authors: Osamu
authors: O
authors: Miyazaki
authors: Seisuke
authors: S
authors: Sakamoto
authors: Hajime
authors: H
authors: Uchida
authors: Takanobu
authors: T
authors: Shigeta
authors: Hidekazu
authors: H
authors: Masaki
mesh_terms: D002648:Child; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D011169:Portal Vein / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D015607:Stents; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*