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| The ‘Unsigned highway’: An alternative route for portal vein anastomosis for non-malignant portal vein thrombosis during pediatric re-transplantation |
| Albert Chi Yan Chan a , ∗ , Wing Chiu Dai a , Patrick Ho Yu Chung b , Wong Hoi She a , Sui Ling Sin a |
a Division of Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong, China
b Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong, Hong Kong, China
∗ Corresponding author.
E-mail address: acchan@hku.hk (A.C.Y. Chan). |
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Abstract Non-malignant portal vein thrombosis (PVT) remains an important issue in liver transplantation due to the technical challenges in re-establishing the portal flow to the liver graft. The prevalence of complex PVT (i.e. Yerdel grade 4) was reported to be around 2.0% [1]. In the early history of liver transplantation, PVT was regarded as a contraindication. As knowledge and techniques improved over the years, different operative strategies have been derived, including direct endovenous thrombectomy [2], jump grafting to superior mesenteric vein (SMV) [3], and renoportal [4] or portocaval anastomosis [3]. However, the majority of these reports focused on flow restoration in adult recipients in whom cirrhosis with portal hypertension was the most common etiology. The wider caliber of mesenteric veins or the availability of shunts rendered such techniques feasible for portal flow restoration in adults. Nonetheless, this may not be possible in pediatric patients, given the size of the vessels, or the lack of spontaneous shunt formations [5]. We herein describe a novel, frequently unnoticed route for portal flow restoration.
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2021, Vol. 20 
