19 Portal vein thrombendvenectomy in cases of portal vein thrombosis at the time of liver transplantation

Molmenti, Ernesto P.; Roodhouse, Thomas W.; Jaiswal, Kshama; Jennings, Linda W.; Sánchez, Elizabeth; Marubashi, Shigeru; Jung, Ghap Joong; Brooks, Barbara K.; Conkey, A; Mulligan, David C.

doi:10.1016/s1527-6465(05)80048-6

Cited by 1 publication

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“…When an end-to-end anastomosis is achieved in a patient with PVT undergoing transplantation, survival is similar to patients without PVT. 23 24 25 26 27 If a physiologic reconstruction is not possible, then nonphysiologic techniques may be employed, including PV arterialization, caval transposition, and renoportal anastomosis. While these nonphysiologic reconstructions can be technically performed, there is little doubt that physiologic inflow is preferred as it is associated with improved outcomes and decreased morbidity and mortality following LT. 28 29 30 31 This was further validated in 2014 by the University of Miami group which demonstrated that 25% of its patients with complete PVT who underwent transplant received nonphysiologic portal venous reconstructions and ultimately had higher rates of gastrointestinal bleeding, PV rethrombosis, and worsened overall survival compared with patients who received physiologic reconstructions.…”

Section: Transplant Surgeon's Dilemmamentioning

confidence: 99%

Portal Vein Recanalization–Transjugular Intrahepatic Portosystemic Shunt (PVR-TIPS) Facilitates Liver Transplantation in Cirrhotic Patients with Occlusive Portal Vein Thrombosis

Swersky

Borja–Cacho²,

Deitch³

et al. 2023

Semin intervent Radiol

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Portal vein thrombosis (PVT) is a heterogeneous condition with multiple possible etiologies and to varying degrees has historically limited candidacy for liver transplant (LT) in the cirrhotic patient population due to resultant difficulties in constructing a robust portal vein anastomosis. While intraoperative approaches to managing PVT are well-described, methods which approximate normal portal physiology are not always feasible depending on the extent of PVT, and other nonphysiologic techniques are linked with substantial morbidity and poor long-term outcomes. Portal vein recanalization–transjugular intrahepatic portosystemic shunt (PVR-TIPS) creation is an efficacious method of restoring physiologic portal flow in cirrhotic patients prior to LT allowing for end-to-end PV anastomosis, and is the product of decades-long institutional expertise in TIPS/LT and the support of a multidisciplinary liver tumor board. To follow is a review of the pertinent pathophysiology of PVT in cirrhosis, the rationale leading to the development and subsequent evolution of the PVR-TIPS procedure, technical lessons learned, and a summary of outcomes to date.

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