scholarly journals Irreversible Electroporation as a Bridge to Liver Transplantation

2019 ◽  
Vol 85 (1) ◽  
pp. 103-110 ◽  
Author(s):  
Robert M. Cannon ◽  
David N. Bolus ◽  
Jared A. White
Keyword(s):  
Liver Transplantation ◽  
High Risk ◽  
Length Of Stay ◽  
Portal Vein ◽  
Irreversible Electroporation ◽  
Vena Cava ◽  
Hepatic Veins ◽  
Bridge To Transplantation ◽  
Adjacent Structures ◽  
Hepatic Vasculature

Hepatocellular carcinoma (HCC) in proximity to major hepatic vasculature poses a risk for invasion, which would contraindicate liver transplantation, yet, is difficult to treat with thermal ablation. This study was undertaken to evaluate the feasibility of irreversible electroporation (IRE) as a bridge to transplantation for high-risk tumors. All patients with HCC in proximity to major hepatic vasculature treated with laparoscopic IRE as bridge to transplantation were studied. Patient and tumor characteristics, length of stay, and treatment-related complications were recorded. Tumor response was assessed with CT and explant pathology. Five patients with a median Model for End Stage Liver Disease (MELD) of 13 (7–21) underwent IRE. The median tumor size was 2.7 cm (1.5–3.7 cm). Adjacent structures included the right portal vein, hepatic veins/inferior vena cava (IVC) and left portal vein. Length of stay was one day for all patients. One patient suffered portal vein thrombosis. The transplant occurred at a median of 142 days (47–264) after IRE. Pathologic necrosis ranged from 30 to 100 per cent, without any vascular invasion. Four patients remain alive with no evidence of disease with median follow-up of 403 (227–623) days. The remaining patients died because of transplant-related complications onpost IRE day 297. IRE shows promise as a bridge to liver transplant for high risk HCC in a preliminary series, justifying further prospective evaluation.

scholarly journals Vascular Involvements in Cholangiocarcinoma: Tips and Tricks

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3735
Author(s):  
Roberta Angelico ◽  
Bruno Sensi ◽  
Alessandro Parente ◽  
Leandro Siragusa ◽  
Carlo Gazia ◽  
...  
Keyword(s):  
Portal Vein ◽  
Hepatic Artery ◽  
Vena Cava ◽  
High Volume ◽  
Vascular Reconstruction ◽  
Ex Situ ◽  
Vascular Involvement ◽  
Hepatic Veins ◽  
Hepatic Artery Resection ◽  
Artery Resection

Cholangiocarcinoma (CCA) is an aggressive malignancy of the biliary tract. To date, surgical treatment remains the only hope for definitive cure of CCA patients. Involvement of major vascular structures was traditionally considered a contraindication for resection. Nowadays, selected cases of CCA with vascular involvement can be successfully approached. Intrahepatic CCA often involves the major hepatic veins or the inferior vena cava and might necessitate complete vascular exclusion, in situ hypothermic perfusion, ex situ surgery and reconstruction with autologous, heterologous or synthetic grafts. Hilar CCA more frequently involves the portal vein and hepatic artery. Resection and reconstruction of the portal vein is now considered a relatively safe and beneficial technique, and it is accepted as a standard option either with direct anastomosis or jump grafts. However, hepatic artery resection remains controversial; despite accumulating positive reports, the procedure remains technically challenging with increased rates of morbidity. When arterial reconstruction is not possible, arterio-portal shunting may offer salvage, while sometimes an efficient collateral system could bypass the need for arterial reconstructions. Keys to achieve success are represented by accurate selection of patients in high-volume referral centres, adequate technical skills and eclectic knowledge of the various possibilities for vascular reconstruction.

scholarly journals Transsplenic portal vein recanalization and direct intrahepatic portosystemic shunt placement to optimize liver transplantation

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Osman Ahmed ◽  
Abhijit L. Salaskar ◽  
Steven Zangan ◽  
Anjana Pillai ◽  
Talia Baker
Keyword(s):  
Liver Transplantation ◽  
Portal Vein ◽  
Splenic Vein ◽  
Portosystemic Shunt ◽  
Refractory Ascites ◽  
Hepatic Veins ◽  
Sonographic Guidance ◽  
Portosystemic Shunts ◽  
Intrahepatic Portosystemic Shunt ◽  
End To End

Abstract Background Percutaneous trans-splenic portal vein recanalization (PVR) has been reported for facilitation of transjugular intrahepatic portosystemic shunts (TIPS), however has not been applied to patients undergoing direct intrahepatic portosystemic shunt (DIPS). We report the utilization of trans-splenic-PVR with DIPS creation in a patient with chronic portal and hepatic vein occlusions undergoing liver transplantation evaluation. Case presentation A 48-year-old male with decompensated alcoholic cirrhosis complicated by refractory ascites, hepatic encephalopathy, and variceal bleeding underwent CT that demonstrated chronic occlusion of the hepatic veins (HV), extrahepatic portal vein (PV), and superior mesenteric vein (SMV). Due to failed attempts at TIPS at outside institutions, interventional radiology was consulted for portal vein recanalization (PVR) with TIPS to treat the portal hypertension and ascites and also facilitate an end-to-end PV anastomosis at transplantation. After an initial hepatic venogram confirmed chronic HV occlusion, a DIPS with trans-splenic PVR was planned. The splenic vein was accessed under sonographic guidance using a micropuncture set and subsequently upsized to a 6 French sheath over a stiff guidewire. A splenic venogram via this access confirmed occlusion of the PV with drainage of the splenic vein (SV) through gastric varices. The thrombosed PV was then recanalized and angioplastied to restore PV flow via the transsplenic approach. A transjugular liver access kit with a modified 21-gauge needle was advanced into the IVC through the internal jugular vein (IJV) sheath and directed towards the target snare in PV. The needle was used to subsequently puncture the PV through the caudate lobe and facilitate placement of a wire into the SV. The initial portosystemic gradient (PSG) was 20 mmHg. The IJV sheath was advanced through the hepatic parenchymal tract into the main-PV and a stent-graft was placed across the main PV and into the IVC. A portal venogram demonstrated brisk blood flow through the DIPS, resolution of varices and a PSG of 8 mmHg. One month after the procedure, the patient had a significant reduction in ascites and MELD-NA score. Patient is currently listed and awaiting transplantation. Conclusions In the setting of chronically occluded portal and hepatic veins, trans-splenic PVR DIPS may serve as an effective bridge to liver transplantation by facilitating an end to end portal vein anastomosis.

scholarly journals ABERNETHY MALFORMATION AS A RARE INDICATION FOR LIVER TRANSPLANTATION: CASE REPORT

2019 ◽  
Vol 141 (5-6) ◽  
pp. 134-137
Keyword(s):  
Liver Transplantation ◽  
Case Report ◽  
Portal Vein ◽  
Liver Tumors ◽  
Splenic Vein ◽  
Vena Cava ◽  
Portal Blood ◽  
Type I ◽  
Abernethy Malformation ◽  
Congenital Cardiac Anomalies

Abernethy malformation or congenital agenesis of the portal vein (CAPV) is a rare malformation of the abdominal splanchnic venous system. This malformation is commonly found in children and is often associated with other malformations such as congenital cardiac anomalies and skeletal system disorders, as well as liver tumors. There are two types of Abernethy malformation. In type I, portal blood bypasses the liver completely, with the superior mesenteric vein and the splenic vein draining into the inferior vena cava separately (type Ia), or together (type Ib). There are no intrahepatic portal vein branches in the liver. Type II is a partial portocaval shunt in which portal blood partially supplies the liver. There is no unified therapeutic approach for all patients with Abernethy malformation, however, liver transplantation is recommended in patients with liver disease (encephalopathy, poor liver function) and those with liver tumors. In this case report we present a case of Abernethy type Ib malformation in a 17-year-old patient with chronic malaise and uper abdominal pain. During diagnostic work-up, an unresectable liver tumor was found and the patient was successfully treated with orthotopic liver transplantation.

Localization of intrahepatic portal vascular resistance

1986 ◽  
Vol 251 (3) ◽  
pp. G375-G381 ◽  
Author(s):  
W. W. Lautt ◽  
C. V. Greenway ◽  
D. J. Legare ◽  
H. Weisman
Keyword(s):  
Pressure Drop ◽  
Portal Vein ◽  
Vascular Resistance ◽  
Venous Pressure ◽  
Vena Cava ◽  
Sympathetic Nerves ◽  
Hepatic Veins ◽  
Pressure Changes ◽  
Stimulation Of ◽  
Anesthetized Cat

The pressure drop from the portal vein to the vena cava occurs primarily across a postsinusoidal site localized to a narrow segment (less than 0.5 cm) of hepatic veins (roughly 1.5 mm diam) in the anesthetized cat. Portal venous pressure (PVP = 8.9 +/- 0.3 mmHg) and lobar hepatic venous pressure (LVP = 8.7 +/- 0.4 mmHg) are insignificantly different, and pressure changes imposed from the presinusoidal or postsinusoidal side are equally transmitted to both pressure sites. Several types of experiments were done to validate the LVP measurement. The portal vein, hepatic sinusoids, and hepatic veins proximal to the resistance site are all under a similar pressure. Previously reported calculations of hepatic vascular resistance are in error because of incorrect assumptions of sinusoidal pressure and localization of the portal resistance site as presinusoidal. Stimulation of hepatic sympathetic nerves for 3 min caused LVP and PVP to increase equally, showing that the increased "portal" resistance is postsinusoidal across the same region of the hepatic veins that was previously localized as the site of resistance in the basal state.

Deployment of Direct Intrahepatic Portocaval Shunt (DIPS) from a Femoral Access

2018 ◽  
Author(s):  
Abdulrahman Masrani ◽  
Bulent Arslan
Keyword(s):  
Portal Vein ◽  
Central Venous Access ◽  
Vena Cava ◽  
Venous Access ◽  
Hepatic Veins ◽  
Portocaval Shunt ◽  
Femoral Access ◽  
Direct Puncture ◽  
The Right ◽  
Brachiocephalic Veins

The transjugular intrahepatic portosystemic shunt (TIPS) has been shown to be effective in management of esophageal varices bleeding in patients with liver cirrhosis when endoscopic manuvers fail to control it. Ascites refractory to optimal medical therapy is another indication for TIPS procedure. Occasionally, TIPS cannot be performed due to vascular anatomical difficulties such as occluded central venous access, small hepatic veins, or portal vein occlusion. Direct intrahepatic portocaval shunt (DIPS) can be considered as an alternative option in such circumstances. DIPS is typically performed utilizing jugular access with direct puncture from the inferior vena cava (IVC) to the right portal vein. However, the interventionalist may be challenged by jugular or brachiocephalic veins occlusion. This chapter discusses perfroming DIPS procedure utilizing femoral access in a patient with bilateral occluded brachiocephalic veins and thrombosed right portal vein.

scholarly journals XXVI. Researches on sugar formation in the liver

1860 ◽  
Vol 150 ◽  
pp. 595-609 ◽  
Keyword(s):  
Portal Vein ◽  
Experimental Research ◽  
Royal Society ◽  
Vena Cava ◽  
Experimental Investigations ◽  
Hepatic Veins ◽  
Animal Diet

The following communication is an abridgement of a paper on the same subject presented to the Royal Society in 1858, with some additional matter that has been since disclosed by my experimental investigations. The original paper, being deposited in the Archives of the Society, is accessible for reference on points of detail that are here excluded. In 1848 it was announced by Bernard that the liver enjoyed a sugar-forming function. This statement appeared to rest upon irrefutable grounds, and the new function soon became almost universally acknowledged by physiologists. An animal which had been for some time previously restricted to an animal diet was suddenly killed. Sugar was found abundantly in the blood of the vena cava and hepatic veins, whilst none existed in that of the portal vein. The tissue of the liver was also found abundantly saccharine, whilst no sugar was to be detected in any other organ. I had seen this experiment several times performed in Bernard’s laboratory, and had often repeated it myself. From the correctness of the description of his results, I entertained no doubt as to the accuracy of Bernard’s deductions, and did not for a moment seek to question them. In the course of my experimental research, however, I was conducted step by step to a point which has placed me, involuntarily as it were, in antagonism with the glycogenic theory. By pushing investigation further than had hitherto been done, I have been compulsorily brought to arrive at conclusions of which I had not the most remote anticipation beforehand.

scholarly journals Irreversible electroporation as a bridge to liver transplantation for high risk HCC

HPB ◽  
2017 ◽  
Vol 19 ◽  
pp. S160
Author(s):  
R. Cannon ◽  
D. Bolus ◽  
S. Gray ◽  
J. White
Keyword(s):  
Liver Transplantation ◽  
High Risk ◽  
Irreversible Electroporation

The Effect of Clamping of Inferior Vena Cava and Portal Vein on Urine Output During Liver Transplantation

2007 ◽  
Vol 39 (4) ◽  
pp. 1197-1198 ◽  
Author(s):  
M.B. Khosravi ◽  
H. Jalaeian ◽  
M. Lahsaee ◽  
S. Ghaffaripour ◽  
H. Salahi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Inferior Vena Cava ◽  
Portal Vein ◽  
Urine Output ◽  
Inferior Vena ◽  
Vena Cava

scholarly journals Protein C in a patient with portal vein thrombosis in liver transplantation

2021 ◽  
Vol 13 (2) ◽  
pp. 151-157
Author(s):  
S. V. Zhuravel ◽  
V. E. Aleksandrova ◽  
N. K. Kuznetsova ◽  
M. S. Novruzbekov ◽  
L. V. Donova
Keyword(s):  
Liver Transplantation ◽  
High Risk ◽  
Plasma Level ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Orthotopic Liver Transplantation ◽  
Protein C ◽  
Post Transplant ◽  
Vein Thrombosis ◽  
Hemostasis System

Background. The problem of thromboses, including those associated with impaired hemostasis system, is relevant in orthotopic liver transplantation.Aim. To present the experience of intraoperative use of protein C during orthotopic liver transplantation in a patient with a high risk of recurrent portal vein thrombosis.Results. During orthotopic liver transplantation in a patient with a high risk of recurrent portal vein thrombosis, the intraoperative administration of the protein C preparation at a dosage of 500 IU contributed to the increase in plasma level of protein C by 48%. In the post-transplant period, recurrent portal vein thrombosis was not observed. Conclusion. Intraoperative administration of protein C in combination with basic therapy for orthotopic liver transplantation helps to prevent recurrent portal vein thrombosis.

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