Balloon-Occlusion Technique for Managing Portal Vein Hemorrhage in Liver Transplantation.
BACKGROUND
Portal vein thrombosis (PVT) is relatively common among candidates for liver transplantation and can present significant intraoperative challenges. Depending on the extent of PVT, thromboendovenectomy (TEV), portal bypass, or systemic inflow may be required to restore portal inflow. While TEV is the most commonly used approach to restore anatomic portal inflow, portal vein injury and life-threatening hemorrhage are risks with this technique.


METHODS
We present a salvage technique for managing portal vein injury during TEV using intraluminal balloon occlusion of the portal vein during portal vein repair and reconstruction. This alternative mode of bleeding control optimizes exposure to the retropancreatic space and avoids direct application of vascular clamps that can cause further injury to the vessel and surrounding tissue.


CONCLUSIONS
Careful preoperative planning and anticipation of potential problems are essential for safe and effective management of complex PVT intraoperatively. The balloon-occlusion technique can facilitate safe and efficient repair of a portal vein injury during TEV for liver transplantation.
Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
John B
JB
Seal
Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
Humberto
H
Bohorquez
Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.
Naren
N
Battula
Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.
Lucia
L
DeGregorio
Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.
Emily
E
Bugeaud
Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.
David S
DS
Bruce
Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
Ian C
IC
Carmody
Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
Ari J
AJ
Cohen
Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
George E
GE
Loss
Endovascular procedures; liver transplantation; portal vein; reconstructive surgical procedures; venous thrombosis