title: The portal vein-variceal anastomosis: an important technique for establishing portal vein inflow.
abstract: BACKGROUND
  Adequate portal vein inflow is critical to successful orthotopic liver transplantation. While an end-to-end donor to recipient portal vein anastomosis is fashioned in the majority of liver transplant recipients, approximately 2% of recipients will require a complex vascular reconstruction due to inadequate recipient portal vein inflow. In this series, we describe our experience with five patients in which porto-variceal anastomosis was used to treat extensive porto-mesenteric thrombosis.
  
  
  METHODS
  Charts for patients who underwent liver transplantation from January 1, 2006, to December 31, 2011, were reviewed for patients requiring porto-variceal anastomosis.
  
  
  RESULTS
  Five patients had extensive porto-splenomesenteric thrombosis requiring utilization of a varix as portal inflow. An iliac vein graft was utilized in four patients, and a direct anastomosis was performed in one patient. The patient with the direct anastomosis required revision with the use of an iliac vein graft the following day. Follow-up imaging documented portal vein patency at a minimum of three months post-transplant. No patients suffered post-operative variceal hemorrhage and all five patients are alive with a functional primary graft at a median follow-up of 2.3 yr.
  
  
  CONCLUSIONS
  A porto-variceal anastomosis should be feasible in the majority of patients with extensive porto-mesenteric thrombosis with excellent durability.
authors.affiliation: Division of Hepatobiliary, Pancreatic and Abdominal Transplant Surgery, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.
authors.forename: Sophoclis P
authors.initials: SP
authors.lastname: Alexopoulos
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Thomas
authors.forename: Emily
authors.initials: E
authors.lastname: Berry
authors.forename: Gilbert
authors.initials: G
authors.lastname: Whang
authors.forename: Lea
authors.initials: L
authors.lastname: Matsuoka
mesh_terms: D000714:Anastomosis, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007084:Iliac Vein / Q000637:transplantation; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D011379:Prognosis; D020246:Venous Thrombosis / Q000209:etiology / Q000601:surgery*
keywords: allograft; liver transplantation; portal vein