Imaging and minimally invasive endovascular therapy in the management of portal vein thrombosis

Abstract Background: Portal vein thrombosis (PVT) after adult liver transplantation (LT) is a rare but serious complication with no consensus on the ideal treatment. We report a case series and a comprehensive review of the literature on PVT after LT to discuss the therapeutic options. Methods: The clinical data of 360 adult patients (≥18 years of age) that underwent LT from January 2015 to January 2018 were reviewed, and a comprehensive search of PubMed and Web of Science was conducted. Patients diagnosed with PVT after LT were identified, and relevant risk factors and therapies were analyzed. Results: Among the 360 patients, seven (2.69%) developed PVT after LT. The onset of PVT within one week after LT was found in six patients (85.71%). Four of these seven patients with PVT received systemic anticoagulation (low molecular weight heparin and warfarin) therapy. Minimally invasive interventional therapies combined with systemic anticoagulation (heparin and warfarin) were applied to three patients, two of whom died because of severe abdominal hemorrhage and liver failure. In the 29 cases reported in the literature, minimally invasive interventional therapy combined with systematic anticoagulation or sclerotherapy were the most used methods (19/29). Systemic anticoagulation was administered to three patients, surgical operation (thrombectomy; portosystemic shunt and retransplantation) was performed for seven patients. Among these 29 patients, four eventually died. Conclusions: In conclusion, interventional therapy combined with systemic anticoagulation is a good choice for the management of PVT after LT, and in our experience, systemic anticoagulation alone can also have a positive effect for early PVT patients.

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Complications of endobiliary minimally invasive percutaneous procedures

Annaly khirurgicheskoy gepatologii = Annals of HPB surgery ◽

10.16931/1995-5464.2019288-99 ◽

2019 ◽

Vol 24 (2) ◽

pp. 88-99

Author(s):

R. G. Avanesyan ◽

M. P. Korolev ◽

L. E. Fedotov ◽

M. M. Turyanchik ◽

S. N. Sabri

Keyword(s):

Postoperative Complications ◽

Mortality Rate ◽

Minimally Invasive ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Bile Leakage ◽

Late Complications ◽

Vein Thrombosis ◽

Percutaneous Procedures ◽

Abdominal Abscesses

Objective. To improve the outcomes of percutaneous endobiliary interventions through prediction of postoperative complications and searching for minimally invasive methods of their treatment. Material and methods. Percutaneous en dobiliary interventions have been performed in 2458 patients for the period from 2006 to 2018 including bile duct stenting in 1895 patients. Results. Early postoperative complications included hemobilia (2.1%), abdominal bleeding (0.2%), duodenal bleeding (0.1%), pleuritis (0.9%), abdominal bile leakage (1.5%) and peritonitis (0.8%), liver hematoma (0.7%), right-sided pleuritis (0.9%), pancreatitis (13.8%). In our opinion, these complications are serious and require immediate intensive care and invasive repair. Mortality rate was 8.4% among all patients with early complications and 0.9% among those after endobiliary interventions. Delayed complications of percutaneous transhepatic interventions are migration of stent or drainage tube, drain incrustation, malignant invasion of stent, recurrent cholangitis, cholangiogenic liver abscesses, abdominal abscesses, sepsis, fragmentation of drain or stent, portal vein thrombosis. The most severe late complications (sepsis and portal vein thrombosis) resulted mortality rate 50–60%. Conclusion. Combined dual (ante- and retrograde) biliary approach and control throughout minimally invasive surgery eliminate disadvantages of individual accesses, reduce invasiveness, postoperative morbidity and mortality.

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