Percutaneous Transhepatic Portography for the Treatment of Early Portal Vein Thrombosis After Surgery |
| |
Authors: | Gian Luigi Adani Umberto Baccarani Andrea Risaliti Massimo Sponza Daniele Gasparini Fabrizio Bresadola Dino de Anna Vittorio Bresadola |
| |
Institution: | (1) Department of Surgery & Transplantation, University Hospital of Udine, Via Colugna 50, 33100 Udine, Italy;(2) Department of Interventional Radiology, University Hospital of Udine, Udine, Italy |
| |
Abstract: | We treated three cases of early portal vein thrombosis (PVT) by minimally invasive percutaneous transhepatic portography.
All patients developed PVT within 30 days of major hepatic surgery (one case each of orthotopic liver transplantation, splenectomy
in a previous liver transplant recipient, and right extended hepatectomy with resection and reconstruction of the left branch
of the portal vein for tumor infiltration). In all cases minimally invasive percutaneous transhepatic portography was adopted
to treat this complication by mechanical fragmentation and pharmacological lysis of the thrombus. A vascular stent was also
positioned in the two cases in which the thrombosis was related to a surgical technical problem. Mechanical fragmentation
of the thrombus with contemporaneous local urokinase administration resulted in complete removal of the clot and allowed restoration
of normal blood flow to the liver after a median follow-up of 37 months. PVT is an uncommon but severe complication after
major surgery or liver transplantation. Surgical thrombectomy, with or without reconstruction of the portal vein, and retransplantation
are characterized by important surgical morbidity and mortality. Based on our experience, minimally invasive percutaneous
transhepatic portography should be considered an option toward successful recanalization of early PVT after major liver surgery
including transplantation. Balloon dilatation and placement of a vascular stent could help to decrease the risk of recurrent
thrombosis when a defective surgical technique is the reason for the thrombosis. |
| |
Keywords: | Early portal vein thrombosis Thrombectomy Percutaneous transhepatic portography Minimally invasive angiographic approach Vascular stent |
本文献已被 PubMed SpringerLink 等数据库收录! |
|