AI Article Synopsis
- Patients with liver transplantation and serious blood vessel issues (Yerdel grade 4) usually don't do as well after surgery.
- In a specific case, doctors faced challenges because the usual methods to fix blood flow couldn't be used due to lots of small clogs.
- They removed the clogs, but problems kept happening until they used special techniques and teamwork, which finally helped the patient’s liver work normally again.
Article Abstract
Patients receiving liver transplantation in a setting of complete portal vein (PV) and superior mesenteric vein (SMV) thrombosis (Yerdel grade 4) experience lower outcomes after surgery; prognosis is independently influenced by the portal flow reconstruction technique, showing better outcomes in physiological surgical strategies. We describe a case of living donor liver transplantation in which the patient could not receive common physiological reconstructions preoperatively due to multiple small collaterals and extensive thrombosis down to first branches of SMV. We performed thromboendovenectomy of the PV and SMV first, but acute thrombosis developed recurrently even with interposition venous homograft between pericholedochal collateral vein and proximal recipient PV. Immediate after surgery, an intervention radiologist performed stent insertion into 3 stenotic points. Through multidisciplinary approach, complete physiological recanalization was obtained with normal liver function.
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| http://dx.doi.org/10.1016/j.ajt.2024.09.033 | DOI Listing |
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