Endovascular Stenting of Portal Vein for Graft Rescue after a Pancreas Transplant Venous Graft Thrombosis: A Case Report

Reslan, Ossama M.; Kirsch, Jordan; Kaul, Hitesh; Campos, Stalin; Zaki, Radi; Brady, Paul S.; Khanmoradi, Kamran

doi:10.1016/j.avsg.2016.11.021

Cited by 6 publications

(4 citation statements)

References 10 publications

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“…Pancreas graft venous thrombosis is not only more often associated with arterial thrombosis [6,7], with prevalence as high as up to 10–20% of cases [9,10], but also much more difficult to treat endovascularly. Due to its rapid progression, the diagnosis is usually too late for endovascular treatment to be successful.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Interventions in Vascular Complications After Simultaneous Pancreas and Kidney Transplantations: A Single-Center Experience

Surowiecka-Pastewka¹,

Matejak-Górska²,

Frączek

et al. 2019

Ann Transplant

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Background Vascular failures are serious complications in pancreas transplantation. Open surgery is a reliable and quick intervention method, but it carries a risk of infection and bleeding. Endovascular procedures are rare among patients after a SPK, but are becoming more frequently used. One of the main risks of the endovascular approach is that the renal function impairment caused by contrast agent. Material/Methods We performed a retrospective analysis of 200 transplanted pancreases at our center over the last 14 years. The analyses included those patients after pancreas transplantation who required the most challenging vascular interventions and ones that were non-standard for the procedure. Results Severe vascular conditions requiring endovascular intervention were observed in 3% of SPKs. In one retransplanted patient, there was an acute ischemia of the lower extremity due to the narrowing of the common iliac artery following a previous transplantectomy, above the new pancreas graft anastomoses. In another patient, local inflammation led to the disruption of the external iliac artery on the level of transplantectomy, caused severe bleeding, and we had to implement a stent-graft to reconstruct the iliac artery wall. A third patient had a pseudoaneurysm demanding further treatment with a stent-graft implemented into the femoral artery due to a pseudoaneurysm of the right external iliac artery. Conclusions Intravenous interventions in patients with a transplanted or retransplanted pancreas are safe and feasible. It is a technically demanding procedure, but the risk of kidney graft function deterioration, as well as of bleeding due to the high dose of heparin used, is lower than with open vascular surgery.

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Section: Discussionmentioning

confidence: 99%

Endovascular Interventions in Vascular Complications After Simultaneous Pancreas and Kidney Transplantations: A Single-Center Experience

Surowiecka-Pastewka¹,

Matejak-Górska²,

Frączek

et al. 2019

Ann Transplant

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“…According Fridell to et al, vascular thrombosis accounts for the majority of the cases of early graft loss [ 10 ]. Routine systemic anticoagulation protocols used by multiple centers are controversial due to an increased risk of bleeding and lack of randomized controlled studies proving their effectiveness [ 14 ]. Despite the lack of clear consensus on the treatment of patients with graft thrombosis, it is clear that some kind of treatment is needed promptly in order to salvage the graft organ [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

The successful salvage of a thrombosed pancreatic graft at the early postoperative period of a simultaneous pancreas and kidney transplantation

Shahbazov

Azari

Whan

et al. 2018

International Journal of Surgery Case Reports

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“…These patients may still ultimately require graft pancreatectomy. 17,28 Though arterial thrombosis is also a common postoperative complication, reported cases of endovascular treatment of pancreatic artery thrombosis (PAT) are sparse and do not have promising outcomes. Saad et al describe 3 patients with PAT treated with pharmacomechanical thrombectomy, none of which demonstrated technical success.…”

Section: Graft Thrombosismentioning

confidence: 99%

“…29 Reslan et al and Stockland et al have both reported cases in which portal vein stenoses were treated with angioplasty followed by self-expanding stent placement. 22,28 Additional Arterial Complications Early postoperative hemorrhage (<30 days) may occur in up to 20 to 25% of the cases and is usually due to inadequate hemostasis at ligated small caliber SMA and splenic artery branches. Less common etiologies include bleeding at the arterial anastomosis, bleeding from the enteric anastomosis resulting in gastrointestinal hemorrhage, and pseudoaneurysm formation secondary to postoperative infection.…”

Section: Graft Stenosismentioning

confidence: 99%

Role of the Interventional Radiologist in Pancreatic Whole Organ and Islet Cell Transplantation

et al. 2019

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Pancreas transplantation is an exciting therapy which has been used for several decades in the treatment of diabetes mellitus. It can be performed as either a whole organ or islet cell transplant. The role of interventional radiologists in the management of whole organ transplants is evolving and includes treatment of postoperative complications and graft biopsy to evaluate for rejection. An in-depth understanding of the transplant anatomy and variations is a fundamental tool in performing these interventions successfully. Islet cell transplantation entails delivery of purified donor pancreatic islet cells into the recipient portal vein. Because of their expertise in image-guided access to the portal system, interventional radiologists play a crucial role in this procedure. The purpose of this article is to review the indications, anatomy, complications, and outcomes of both whole organ and islet cell pancreas transplants, followed by a discussion of the role of interventional radiologists in each procedure.

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Endovascular Stenting of Portal Vein for Graft Rescue after a Pancreas Transplant Venous Graft Thrombosis: A Case Report

Cited by 6 publications

References 10 publications

Endovascular Interventions in Vascular Complications After Simultaneous Pancreas and Kidney Transplantations: A Single-Center Experience

Endovascular Interventions in Vascular Complications After Simultaneous Pancreas and Kidney Transplantations: A Single-Center Experience

The successful salvage of a thrombosed pancreatic graft at the early postoperative period of a simultaneous pancreas and kidney transplantation

Role of the Interventional Radiologist in Pancreatic Whole Organ and Islet Cell Transplantation

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