Endovascular Treatment of Spleno-Mesenteric-Portal Vein Thrombosis During Orthotopic Liver Transplant: 20 Years Later

Abstract

PurposeOur purpose is to present our experience in endovascular treatment of portal vein thrombosis (PVT) during orthotopic liver transplant (OLT), initial stages, and long-term follow-up. Materials and methodsBetween May 1994 and December 2019 we performed 1246 OLTs. A total of 170 (13.64%) had some grade of PVT at the time of OLT. Since May 2000 we have performed endovascular procedures during OLT in 52 patients with PVT grade III to IV Yerdel classification. Our research consists of the 49 patients with more than 1 year of follow-up. The initial surgical technique was eversion thromboendovenectomy when the portal flow was not adequate. Intraoperative portography and endovascular treatments were taken via the graft umbilical vein, one of the recipients’ mesenteric veins, the recipient portal vein, or the graft portal vein. If the cause was an obstructive or incomplete thrombus removal, venoplasty and primary stent placement were performed. ResultsPrimary stent placement was achieved in 47 of 49 patients (95.9%): adequate portal perfusion in the allograf and portal hypertension were achieved. None of the patients died during surgery or at 30 days. At long-term follow-up, 3 patients (6.1%) had a portal vein rethrombosis due to no related causes. Cumulative survival rates were 89.7%, 79.3%, and 65.5% at 1, 5, and 10 years. ConclusionsStent placement in PVT during OLT is a safe and effective procedure to resolve liver graft perfusion. It is an anatomic and physiological derivation that guarantees appropriate hepatopetal portal flow to avoid rethrombosis and portal hypertension, with low mortality and morbility.