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No‐Touch Hepatic Hilum Technique to Treat Early Portal Vein Thrombosis After Pediatric Liver Transplantation
Author(s) -
Bueno J.,
PerezLafuente M.,
Venturi C.,
Segarra A.,
Barber I.,
Molino J. A.,
Romero A.,
Ortega J.,
Bilbao I.,
MartinezIbañez V.,
Charco R.
Publication year - 2010
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2010.03236.x
Subject(s) - medicine , surgery , portal vein thrombosis , hilum (anatomy) , thrombosis , catheter , liver transplantation , transplantation , superior mesenteric vein , radiology , portal vein
A ‘no‐touch’ hilum technique used to treat early portal vein complications post‐liver transplantation in five children with body weight <10 kg is described. Four patients developed thrombosis and one portal flow absence secondary to collateral steal flow. A vascular sheath was placed through the previous laparotomy in the ileocolic vein (n = 2), inferior mesenteric vein (n = 1) or graft umbilical vein (n = 1). Portal clots were mechanically fragmented with balloon angioplasty. In addition, coil embolization of competitive collaterals (n = 3) and stent placement (n = 1) were performed. The catheter was left in place and exteriorized through the wound (n = 2) or a different transabdominal wall puncture (n = 3). A continuous transcatheter perfusion of heparin was subsequently administered. One patient developed recurrent thrombosis 24 h later which was resolved with the same technique. Catheters were removed surgically after a mean of 10.6 days. All patients presented portal vein patency at the end of follow‐up. Three patients are alive after 5 months, 1.5 and 3.5 years, respectively; one patient required retransplantation 18 days postprocedure and the remaining patient died of adenovirus infection 2 months postprocedure. In conclusion, treatment of early portal vein complications following pediatric liver transplantation with this novel technique is feasible and effective.