Novel Use of Percutaneous Thrombosuction for Hepatic Vein Thrombosis of the Liver Graft after Liver Transplantation

Abstract

Introduction: Early thrombosis of hepatic vein graft of liver graft after living related donor liver transplantation (LDLT) is a challenging problem and poses a high potential of graft failure or/and patient failure. Re-exploration faces the risk of repeated general anesthesia, adhesion and anatomical difficulty, family’s attitude, and the potential of rethrombosis. Methods: A 54-year-old woman with hepatitis B viral infection related liver cirrhosis with two hepatocellular carcinoma (cT2N0M0 stage II) received LDLT with right hepatic lobe donated by her daughter. The outflow reconstruction using an artificial vascular conduit included the V5 and V8 with end-to-side anastomosis each. Anastomosis of the conduit with right hepatic vein orifice on IVC of the recipient was performed with 4-0 prolene suture. The liver enzyme, total bilirubin and lactate elevated since the 7th day postoperation. CT study showed thrombosis of V5 and V8 with hypoenhancement of the corresponding liver parenchyma. The hepatic artery and the portal vein were patent. Results: Heparin 5000U was given intravenously. After local anesthesia, we inserted a 7-French (Fr) sheath through right femoral vein, then 7-Fr Judkins guide catheter to approach hepatic vein, wiring to distal V5 branch with 0.014" HydroST wire (COOK medical). Thrombosuction with 7-Fr Pronto V4 (Vascular Solution) to extract thrombus was repeated smoothly. Balloon catheter angiography showed good flow from V5 to IVC. The function of the graft recovered and she discharged at the end of 3rd week after transplantation. She remained well for 6 months up to now. Conclusion: Thrombosuction had been used in the treatment of deep vein thrombosis of lower limbs, pulmonary embolism, thrombosis of hemodialysis fistula or of coronary vessels. We applied it for liver graft to avoid repeated major surgery and general anesthesia. To follow up imaging studies and appropriate anticoagulant therapy are necessary for those who had an episode of graft vein thrombosis.