New Thrombectomy Technique for Total Portal Vein Thrombosis in Liver Transplantation

Portal vein thrombosis is present in approximately 5-16% of patients with end-stage liver disease who undergo liver transplantation. In this report, we describe a new surgical approach that has been established in our center. Two patients with total thrombosis of the main trunk of the portal vein have been treated currently. Briefly, the portal vein was dissected as caudally as needed to reach an area without thrombus and occlude its cranial portion near the liver. Incision of the portal vein was then performed without cutting the thrombus and by everting the portal vein wall, carefully liberating it from the thrombus until it was removed entirely and remained attached to the native liver. With this new thrombectomy technique, we achieved excellent portal flow in both cases, since the thrombus was not fractured and was entirely removed, leading to optimal reperfusion of the liver graft. Both patients underwent control abdominal CT scans days after the liver transplant, in which no residual thrombi and excellent portal flow in the graft were observed. This novel thrombectomy technique seems safe and feasible, although further experience is necessary to evaluate its long-term outcomes.