Endovascular Treatment of Acute Portal Vein Thrombosis After Liver Transplantation in a Child

Abstract

Although operative techniques in hepatic transplantation have reduced the time and mortality on waiting lists, the rate of vascular complications associated with these techniques has increased. Stenosis or thrombosis of the portal vein is an infrequent complication, and if present, surgical treatment is considered the traditional management. This article describes a case of acute portal vein thrombosis after liver transplantation from a living donor to a child managed by percutaneous techniques.

Early posttransplantation portal vein stenosis following living donor liver transplantation: Percutaneous transhepatic primary stent placement

“…We preferred to perform primary stent placement rather than balloon angioplasty for 2 reasons. First, although anastomotic rupture had not occurred in previous reports,4, 5 we could not exclude the possibility of anastomotic rupture of a fresh anastomotic stenosis. Although to our knowledge there have been no reports regarding the optimal interval for balloon angioplasty following living donor liver transplantation, we believe that there may not be sufficient healing of a vascular anastomosis within a month following living donor liver transplantation as the recipients have also undergone immune suppressive treatment.…”

“…To date, little is known about the role of percutaneous interventional procedures for treating early postoperative PV stenosis or thrombosis. Carnevale et al4 and Cherukuri et al5 each reported 1 patient with early posttransplantation (on postoperative days 8 and 10, respectively) PV thrombosis; both of these patients were treated successfully with percutaneous thrombolysis or thrombectomy followed by stent placement. In both of these series, balloon angioplasty was also performed without complications, although stent placement was required due to remaining stenosis following balloon angioplasty.…”

“…Although to our knowledge there have been no reports regarding the optimal interval for balloon angioplasty following living donor liver transplantation, we believe that there may not be sufficient healing of a vascular anastomosis within a month following living donor liver transplantation as the recipients have also undergone immune suppressive treatment. Second, PV stenosis occurring in the early posttransplantation period is considered to be secondary to technical factors such as a tight suture line, discrepancy of the PV size, tension or twisting of the PV in the area of the anastomosis caused by the orientation of the donor liver in the abdominal cavity, or extrinsic compression of the PV caused by hematoma and reactive edema 1, 4, 8, 10. We presume that stenosis caused by such factors, except for a tight suture line, could not be corrected by balloon angioplasty alone.…”

“…Balloon angioplasty has been used successfully to treat some patients who experienced early posttransplantation PV stenosis or thrombosis 3–5. However, the number of such patients was limited and some of these patients had to undergo stent placement following balloon angioplasty because of remaining stenosis.…”

No‐Touch Hepatic Hilum Technique to Treat Early Portal Vein Thrombosis After Pediatric Liver Transplantation

“…Unfortunately, these surgical procedures have been associated with significant morbidity, mortality and recurrence rates (2)(3)(4). Alternatively, percutaneous transhepatic balloon angioplasty has been used successfully to treat some patients with PV stenosis or thrombosis (5)(6)(7)(8)(9). However, in the early postoperative course, the role of this procedure is controversial since patients have a high risk of developing complications such as hemorrhage (6) (1,4,10,12,13).…”