Emergent nonconventional mesosystemic shunt for diffuse portomesenteric thrombosis: Sparing patients from liver/multivisceral transplantation

Nagai, Shunji; Abouljoud, Marwan; Kazimi, Marwan; Yoshida, Atsushi

doi:10.1002/lt.23647

Cited by 2 publications

(1 citation statement)

References 6 publications

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“…To our knowledge, this is the first report in literature of portal extra-anatomic jump graft from the right colic vein with donor iliac vein interposition. In an emergent condition like a complete portomesenteric thrombosis, a flexible and creative approach with an understanding of the mesenteric venous anatomy and collaterals may save the patient from a multivisceral transplantation [ 11 ]. Moreover, the technique should be relatively simple and reproducible.…”

Section: Discussionmentioning

confidence: 99%

Extra-Anatomic Jump Graft from the Right Colic Vein: A Novel Technique to Manage Portal Vein Thrombosis in Liver Transplantation

Magistri

Tarantino

Olivieri

et al. 2018

Case Reports in Surgery

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Background In the context of cirrhosis, portal vein thrombosis (PVT) is present in 2.1% to 26% of patients. PVT is no longer considered an absolute contraindication for liver transplantation, and nowadays, surgical strategies depend on the extent of PVT. Complete PVT is associated with higher morbidity rates and poor prognosis, while comparable long-term outcomes can be achieved as long as physiological portal inflow is restored. Materials and Methods We report our experience with a 45-year-old patient undergoing liver transplant with a PVT (stage III-b). To restore portal vein inflow to the liver, an extra-anatomic jump graft from the right colic vein with donor iliac vein interposition was constructed. Results The patient recovered well, with a progressive improvement of the general conditions, and was finally discharged on p.o.d. 14. No anastomotic defects were found at the postoperative CT scan 10 months after the surgery. Conclusion Our technical innovation represents a valid and safe alternative to the cavoportal hemitransposition, providing a proper flow restoration and reproducing a physiological setting, while avoiding the complications related to the cavoportal shunt. We believe that the reconstitution of liver portal inflow should be obtained with the most physiological approach possible and considering long-term liver function.

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Section: Discussionmentioning

confidence: 99%

Extra-Anatomic Jump Graft from the Right Colic Vein: A Novel Technique to Manage Portal Vein Thrombosis in Liver Transplantation

Magistri

Tarantino

Olivieri

et al. 2018

Case Reports in Surgery

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Surgical Options for the Management of Portal Hypertension

Abouljoud

Malinzak

Bruno

2015

Curr Hepatology Rep

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In the current age of endoscopic and interventional radiologic management of bleeding varices, the paradigm of surgical management for portal hypertension has radically shifted. There remains, however, a less common but important role for the well-trained surgeon who understands and is capable of managing portal hypertension. Patients who may benefit from surgical intervention are those with early cirrhosis or non-cirrhotic portal hypertension and suffer from variceal bleeding due to the consequences of portal, mesenteric, or splenic vein thrombosis. In addition, good surgical candidates who have limited access to care, may not be capable of close follow-up, or who have had failed prior therapy can benefit from more definitive surgical shunting. Liver transplantation has also changed the landscape in managing portal hypertension as the ultimate treatment for patients with advanced cirrhosis. Limited indications and fewer surgeons having been exposed to shunting procedures for portal hypertension have resulted in fewer shunts being performed, though they remain indicated under special circumstances. It is critical that we discern the role of various treatment options in different clinical scenarios and appreciate that under certain circumstances, a surgical intervention is indicated. This article reviews the history and progression of surgery for portal hypertension and highlights the current role of the surgeon in the era of multidisciplinary intervention. Furthermore, an algorithm for current management of variceal bleeding is presented.

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Emergent nonconventional mesosystemic shunt for diffuse portomesenteric thrombosis: Sparing patients from liver/multivisceral transplantation

Cited by 2 publications

References 6 publications

Extra-Anatomic Jump Graft from the Right Colic Vein: A Novel Technique to Manage Portal Vein Thrombosis in Liver Transplantation

Extra-Anatomic Jump Graft from the Right Colic Vein: A Novel Technique to Manage Portal Vein Thrombosis in Liver Transplantation

Surgical Options for the Management of Portal Hypertension

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