title: Percutaneous Retroperitoneal Splenorenal Shunt for Symptomatic Portal Vein Thrombosis After Liver Transplantation.
abstract: Acute or recurrent bleeding from ectopic varices is a potentially life-threatening condition in rare patients with extrahepatic complete portal vein thrombosis (PVT) after liver transplantation (LT). In this setting, the role of interventional radiology is very limited and surgical shunts, in particular splenorenal shunts are usually used, despite the high associated mortality. We present the first reports of the clinical use of a new minimally invasive technique, percutaneous retroperitoneal splenorenal shunt (PRESS), in two LT recipients with life-threatening variceal hemorrhage secondary to PVT. Both patients had a successful PRESS using a transplenic approach with resolution of bleeding, avoiding the need for a potentially complicated laparotomy. The PRESS procedure is a useful addition to the interventional armamentarium that can be used in cases unsuitable for surgical shunt, and refractory to endoscopic management. In the future, this technique may be an alternative to surgical shunts as the standard procedure in patients with extra-hepatic PVT, just as the transjugular intrahepatic portosystemic shunt (TIPS) procedure has become for the management of portal hypertension in the absence of PVT. Longer-term follow-up will be needed to establish the long-term success of this procedure.
authors.affiliation: Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|Centenary Research Institute, University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Pulitano
authors.affiliation: Radiology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Rogan
authors.affiliation: Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Sandroussi
authors.affiliation: Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Verran
authors.affiliation: Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|Centenary Research Institute, University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: G W
authors.initials: GW
authors.lastname: McCaughan
authors.affiliation: Radiology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Waugh
authors.affiliation: Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Crawford
mesh_terms: D000328:Adult; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D011169:Portal Vein / Q000473:pathology*; D013164:Splenorenal Shunt, Surgical; D020246:Venous Thrombosis / Q000473:pathology*; D055815:Young Adult
keywords: Clinical research / practice; anatomy; complication; liver transplantation / hepatology