Successful Interventional Therapy for Portal Vein Stenosis after Ex Vivo Liver Resection and Autotransplantation in End-Stage Hepatic Alveolar Echinococcosis with Cavernous Transformation.

Abstract

BACKGROUND End-stage hepatic alveolar echinococcosis (AE) can result in cavernous transformation of the portal vein (CTPV) due to extensive invasion of the portal vein. Ex vivo liver resection and autotransplantation (ELRA) is a new treatment option for patients with end-stage hepatic AE combined with CTPV. ELRA can achieve radical resection of HAE lesions and vascular reconstruction, and also effectively controls bleeding, particularly in cases involving multiple tortuous PV collaterals. Unfortunately, postoperative complications related to the portal vein can impede liver blood flow, thereby increasing the risk of portal hypertension and eventual failure of the transplanted liver if not promptly treated through appropriate medical interventions. CASE REPORT We report the case of a 31-year-old woman who underwent ELRA for end-stage hepatic AE combined with CTPV, and early postoperative portal vein anastomotic stenosis occurred. Stenting of the portal vein was performed after clarification of the stenotic segment by portal venography, followed by anticoagulation therapy and close ultrasound follow-up. After the operation, the patient's portal vein anastomosis widened and the blood flow into the liver returned to normal, avoiding graft liver failure. At 3-year follow-up, the portal vein stent was patent and no serious portal vein complications such as thrombosis had occurred. CONCLUSIONS ELRA provides a new therapeutic approach for patients with HAE combined with CTPV, and intraoperative portal vein reconstruction is one of the key procedures. For CTPV patients with early postoperative portal vein stenosis, interventional therapy (IVR) offers fresh perspectives and avoids acute liver failure caused by liver hypoperfusion.