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Preoperative successful thrombectomy and thrombolysis of acute extensive splanchnic venous system and TIPSS thrombosis in a child with Budd‐Chiari syndrome—Creating a window to enable living donor liver transplantation
Author(s) -
Sonavane Amey,
Raut Vikram,
Marar Shaji,
Sawant Ambreen,
Shah Ketul,
Raj Amruth,
Thorat Ashok,
Chaksota Harshit,
Bagde Abhijit,
Verma Rahul,
Dharmapalan Dhanya,
Vasanth Suresh,
Nagral Aabha,
Mirza Darius,
Yewale Vijay
Publication year - 2021
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13857
Subject(s) - medicine , thrombolysis , thrombus , liver transplantation , thrombosis , venous thrombosis , surgery , portal vein thrombosis , cirrhosis , splanchnic , portal venous system , transplantation , superior mesenteric vein , radiology , portal hypertension , portal vein , cardiology , blood flow , myocardial infarction
Preoperative extensive PV thrombosis can pose a technical challenge during liver transplantation surgery. Several strategies adopted to mitigate this problem include creation of a superior mesenteric vein—PV jump graft, use of a polytetrafluoroethylene graft, renoportal anastomosis, or cavoportal hemitransposition. Extensive and diffuse thrombosis of the splanchnic venous system may even necessitate multivisceral transplantation. We describe the case of a pediatric patient with Budd‐Chiari syndrome and decompensated cirrhosis, who developed extensive thrombosis of the porto‐spleno‐mesenteric venous system prior to liver transplantation. We used a combination technique of thrombus aspiration by a novel trans‐TIPPS approach followed by thrombolysis. Complete preoperative resolution of the extensive thrombosis was achieved. This allowed the creation of a brief window to enable planned LDLT. In prudently selected patients, performing an early mechanical and chemical thrombolysis of an extensive acute splanchnic venous thrombosis can thus help expedite a planned LDLT.