Intraoperative portal vein stenting through umbilical vein approach: An innovative salvage procedure for portal vein thrombosis in pediatric liver transplant.
intraoperative
living donor liver transplant
pediatric liver transplant
portal vein stenting
umbilical vein
Journal
Pediatric transplantation
ISSN: 1399-3046
Titre abrégé: Pediatr Transplant
Pays: Denmark
ID NLM: 9802574
Informations de publication
Date de publication:
02 2023
02 2023
Historique:
revised:
07
10
2022
received:
24
08
2022
accepted:
17
10
2022
pubmed:
4
11
2022
medline:
11
1
2023
entrez:
3
11
2022
Statut:
ppublish
Résumé
IPVS is considered a last resort or a salvage procedure in the event of recurrent PV thrombosis despite multiple attempts at redo PV anastomosis. We employed the opened umbilical vein approach to place the stent in the PV and deliver anticoagulation through a catheter. From Jan 2017 to Feb 2022, 150 patients underwent pediatric transplantation at department of liver transplant and hepatobiliary surgery unit, Indraprastha Apollo hospitals, New Delhi. Age, weight, PELD Score, diagnosis, portal vein diameter on preoperative CT, Portal flow after stenting, decrease in spleen size after stenting in follow-up CT were collected from a prospectively maintained data base and reviewed. Eight patients underwent IPVS following LDLT (mean age-10.6 ± 2.2 months, mean weight 8.1 ± 1.6, mean PELD score 32.7 ± 7.3). The mean PV diameter on preoperative CT scan was 3.6 mm (range 2.7-5.6 mm). The mean portal flow following stenting was 718.75 cc/min. Percentage reduction in size of the spleen was 26.35% beyond 2nd post-operative week. No patient had recurrent PV thrombosis following IPVS and all maintained an adequate portal flow throughout the immediate postoperative period. Two patients had in-hospital mortality secondary to septic complications. Umbilical vein approach is technically feasible, easy to manipulate the stent and catheter placement after stenting helps to deliver anticoagulants locally.
Sections du résumé
BACKGROUND
IPVS is considered a last resort or a salvage procedure in the event of recurrent PV thrombosis despite multiple attempts at redo PV anastomosis. We employed the opened umbilical vein approach to place the stent in the PV and deliver anticoagulation through a catheter.
MATERIALS AND METHODS
From Jan 2017 to Feb 2022, 150 patients underwent pediatric transplantation at department of liver transplant and hepatobiliary surgery unit, Indraprastha Apollo hospitals, New Delhi. Age, weight, PELD Score, diagnosis, portal vein diameter on preoperative CT, Portal flow after stenting, decrease in spleen size after stenting in follow-up CT were collected from a prospectively maintained data base and reviewed.
RESULTS
Eight patients underwent IPVS following LDLT (mean age-10.6 ± 2.2 months, mean weight 8.1 ± 1.6, mean PELD score 32.7 ± 7.3). The mean PV diameter on preoperative CT scan was 3.6 mm (range 2.7-5.6 mm). The mean portal flow following stenting was 718.75 cc/min. Percentage reduction in size of the spleen was 26.35% beyond 2nd post-operative week. No patient had recurrent PV thrombosis following IPVS and all maintained an adequate portal flow throughout the immediate postoperative period. Two patients had in-hospital mortality secondary to septic complications.
CONCLUSION
Umbilical vein approach is technically feasible, easy to manipulate the stent and catheter placement after stenting helps to deliver anticoagulants locally.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14427Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
Chen CY, Tseng HS, Lin NC, et al. A bidirectional approach for portal vein stent placement in a child with complete portal vein occlusion after living donor liver transplantation. Pediatr Transplant [Internet]. 2013;17(6):E137-E140.
Cheng YF, Ou HY, Tsang LLC, et al. Vascular stents in the management of portal venous complications in living donor liver transplantation. Am J Transplant off J Am Soc Transplant Am Soc Transpl Surg. 2010;10(5):1276-1283.
Kim YJ, Ko GY, Yoon HK, Shin JH, Ko HK, Sung KB. Intraoperative stent placement in the portal vein during or after liver transplantation. Liver Transplant off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2007;13(8):1145-1152.
Ko GY, Sung KB, Lee S, et al. Stent placement for the treatment of portal vein stenosis or occlusion in pediatric liver transplant recipients. J Vasc Interv Radiol JVIR. 2007;18(10):1215-1221.
Czerwonko ME, Pekolj J, Mattera J, et al. Intraoperative stent placement for the treatment of acute portal vein complications in pediatric living donor liver transplantation. Langenbecks Arch Surg. 2019;404(1):123-128.
Chen CL, Cheng YF, Huang V, et al. P4 stump approach for intraoperative portal vein stenting in pediatric living donor liver transplantation: an innovative technique for a challenging problem. Ann Surg. 2018;267(3):e42-e44.
No-touch hepatic hilum technique to treat early portal vein thrombosis after pediatric liver transplantation - PubMed [Internet]. https://pubmed.ncbi.nlm.nih.gov/20887425/. Accessed 23 June, 2022.
Katano T, Sanada Y, Hirata Y, et al. Endovascular stent placement for venous complications following pediatric liver transplantation: outcomes and indications. Pediatr Surg Int. 2019;35(11):1185-1195.
González-Tutor A, Abascal F, Cerezai L, Bustamante M. Transjugular approach to treat portal vein stenosis after liver transplantation--a case report. Angiology. 2000;51(6):511-514.
Breschan C, Platzer M, Jost R, Stettner H, Likar R. Size of internal jugular vs subclavian vein in small infants: an observational, anatomical evaluation with ultrasound. Br J Anaesth. 2010;105(2):179-184.
Joshi M, Wilson G, Engelhardt T. Comparison of landmark technique and ultrasound guidance for localisation of long saphenous vein in infants and children. Emerg Med J EMJ. 2010;27(6):443-445.
Dalzell C, Vargas PA, Soltys K, Di Paola F, Mazariegos G, Goldaracena N. Technical aspects and considerations of meso-rex bypass following liver transplantation with left lateral segment grafts: case report and review of the literature. Front Pediatr. 2022;10:868582.
Ko GY, Sung KB, Yoon HK, Lee S. Early posttransplantation portal vein stenosis following living donor liver transplantation: percutaneous transhepatic primary stent placement. Liver Transplant off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2007;13(4):530-536.