Ann Surg Treat Res.  2014 Jul;87(1):47-50. 10.4174/astr.2014.87.1.47.

The paracholedochal vein: a feasible option as portal inflow in living donor liver transplantation

• Kim JD
• Choi DL
• Han YS

• KMID: 1804100
• DOI: http://doi.org/10.4174/astr.2014.87.1.47

Abstract

Extensive thrombosis of the portal and splenomesenteric veins combined with cavernous transformation of the portal vein (CTPV) has been considered to be a contraindication for living donor liver transplantation (LDLT) due to technical difficulties and perioperative risks. In recent years, several surgical innovations including cavoportal hemitransposition, renoportal anastomosis, and portal arterialization have been introduced to overcome diffuse portal vein thrombosis (PVT) and CTPV, but their outcomes were unsatisfactory with significant morbidity and mortality. Herein, we report two successful cases of adult LDLT in diffuse PVT with CTPV managed using the paracholedochal vein as portal inflow to the graft.

Keyword

Cavernous transformation of portal vein; Liver transplantation; Living donors

MeSH Terms

Adult
Humans
Liver Transplantation*
Living Donors*
Mortality
Portal Vein
Thrombosis
Transplants
Veins*
Venous Thrombosis

Figure

• 

  Fig. 1 (A) Preoperative CT showed diffuse portal vein thrombosis (arrow) extended to superior mesenteric vein (SMV) and marked dilated paracholedochal veins (arrowhead). (B) Schematic illustration of cavernous transformation of the portal vein found at CT and mesenteric venography showed large tortuous paracholedochal collaterals (arrows) and complete invisibility of main portal vein and proximal SMV due to thrombosis. PV, portal vein; SV, splenic vein; GEV, gastroepiploic vein.

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  Fig. 2 (A) End-to-end portal anastomosis was constructed between the graft and common cloaca formed by the confluence of paracholedochal veins (arrowhead). (B) Good portal vein patency to the graft (arrow) was demonstrated by dynamic computed tomography on the 14th postoperative day.

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  Fig. 3 (A) The complex common orifice formed by venoplasty from paracholedochal collaterals and native portal vein was anastomosed to the donor portal vein (arrowhead). (B) Serial postoperative Doppler studies demonstrated satisfactory portal vein flow to the graft.

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