Yonsei Med J.  2015 Mar;56(2):586-590. 10.3349/ymj.2015.56.2.586.

Usefulness of Artificial Jump Graft to Portal Vein Thrombosis in Deceased Donor Liver Transplantation

• Hwang HP
• Yang JD
• Bae SI
• Hwang SE
• Cho BH
• Yu HC

• KMID: 2070043
• DOI: http://doi.org/10.3349/ymj.2015.56.2.586

Abstract

Severe portal vein thrombosis (PVT) is often considered a relative contraindication for living donor liver transplantation due to high associated risks and morbidity. Meanwhile, improvement in operative techniques, resulting in higher success rates has removed PVT from the list of contraindications in deceased donor liver transplantation (DDLT). In this report, we describe a surgical technique for DDLT using polytetrafluoroethylene graft from the inferior mesenteric vein for portal inflow in patient with portomesenteric thrombosis.

Keyword

Liver transplantation; portal vein thrombosis; artificial graft; inferior mesenteric vein; polytetrafluoroethylene

MeSH Terms

End Stage Liver Disease/complications/*surgery
Humans
Liver Transplantation/*methods
Male
Mesenteric Veins/surgery
Middle Aged
Polytetrafluoroethylene
Portal Vein/*surgery
Tissue Donors
Treatment Outcome
Ultrasonography, Doppler
*Vascular Grafting
Venous Thrombosis/etiology/*surgery/ultrasonography
Polytetrafluoroethylene

Figure

• 

  Fig. 1 Portal venous thrombosis is shown in preoperative computed tomography (A and B, maximum intensity projection of serial coronal view). Thrombosis was extended to the proximal superior mesenteric vein (dot line; length, 6.8 cm) for a Yedel classification Grade 3. PV, portal vein; PVT, portal vein thrombosis; SMV, superior mesenteric vein; SMA, superior mesenteric artery; IMV, inferior mesenteric vein.

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  Fig. 2 After thrombectomy and lower dissection, portal vein anastomosis with polytetrafluoroethylene (PTFE; arrow) vascular artificial graft was performed with continuous running suture using polypropylene (A). Since massive bleeding and adhesion precluded the possibility of distal superior mesenteric vein interposition, we performed anastomosis between the proximal inferior mesenteric vein and distal portal vein using PTFE (B; schematic representation). PV, portal vein; SMV, superior mesenteric vein; IMV, inferior mesenteric vein.

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  Fig. 3 Postoperative computed tomography at post operative 7 days (A) and 27 months (B) shows that the polytetrafluoroethylene graft has no thrombosis and no anastomotic stricture. PTFE, polytetrafluoroethylene; IMV, inferior mesenteric vein.

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