| Renoportal anastomosis as a rescue technique in postoperative portal thrombosis in liver transplantation. | |
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MedLine Citation:
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PMID: 19376426 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Renoportal anastomosis has been used as the primary portal revascularization technique in grade 4 portal thrombosis, but never after posttransplant portal thrombosis. A cirrhotic patient with hepatocellular carcinoma and partial portal thrombosis of two-thirds of the lumen was transplanted. The thrombus was removed and good portal flow obtained upon reperfusion (2.8 L/min). On the ninth postoperative day Doppler ultrasound revealed complete portal thrombosis extending from the splenomesenteric confluence. At emergency reoperation, we removed the newly formed thrombus. Portal vein branches were flushed with heparin and urokinase. After reconstruction of the anastomosis, we achieved a flow of 1.1 L/min. Rethrombosis occurred again on day 13. At reoperation, thrombus was removed again. However, this time portal flow was not recovered, due to hepatofugal flow associated with both the presence of collaterals and pancreatic edema. A left renoportal anastomosis was performed using an interposed iliac vein graft. A catheter was placed into the portal vein through a recanalization of the umbilical vein of the graft. After urokinase perfusion, portal inflow was 1.7 L/min. The postoperative course was satisfactory, with progressive normalization of liver tests and no further thrombosis. Persistent ascites improved with treatment. Angiography on day 41 showed good portal flow from the renal vein, with uniform distribution within the liver. A renoportal anastomosis can be useful for recovery of liver failure after posttransplant portal thrombosis, in the absence of portal flow. |
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Authors:
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I M González-Pinto; A Miyar; C García-Bernardo; L Vázquez; L Barneo; E Cortés; P Díaz; N Gutiérrez; L Fernández; M Moreno |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Transplantation proceedings Volume: 41 ISSN: 0041-1345 ISO Abbreviation: Transplant. Proc. Publication Date: 2009 Apr |
Date Detail:
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Created Date: 2009-04-20 Completed Date: 2009-07-29 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0243532 Medline TA: Transplant Proc Country: United States |
Other Details:
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Languages: eng Pagination: 1057-9 Citation Subset: IM |
Affiliation:
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Hospital Universitario Central de Asturias, Celestino Villamil, Oviedo, Spain. igpinto@hotmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Anastomosis, Surgical
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methods Carcinoma, Hepatocellular / surgery Hepatitis C / complications, surgery Humans Liver Cirrhosis / complications, surgery Liver Function Tests Liver Neoplasms / surgery Liver Transplantation / methods* Male Middle Aged Portal Vein / surgery* Postoperative Complications / surgery Renal Veins / radiography, surgery Reoperation Treatment Outcome Varicose Veins / radiography Venous Thrombosis / surgery* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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