Transplantation Direct (Jan 2023)

Percutaneous Direct Puncture of Retropancreatic Splenic Vein and Portal Thrombectomy in a Patient With Liver Transplantation and Simultaneous Splenectomy

  • Takanobu Hara, MD, PhD,
  • Akihiko Soyama, MD, PhD,
  • Hideki Ishimaru, MD, PhD,
  • Hajime Matsushima, MD, PhD,
  • Hajime Imamura, MD, PhD,
  • Shuto Miyamura, MD,
  • Takashi Hamada, MD, PhD,
  • Kunihito Matsuguma, MD,
  • Masayuki Fukumoto, MD,
  • Takayuki Tanaka, MD, PhD,
  • Tomohiko Adachi, MD, PhD,
  • Masaaki Hidaka, MD, PhD,
  • Susumu Eguchi, MD, PhD

DOI
https://doi.org/10.1097/TXD.0000000000001425
Journal volume & issue
Vol. 9, no. 1
p. e1425

Abstract

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Portal vein thrombosis following liver transplantation is generally managed by endovascular treatment. Although several techniques are available for portal venous access, trans-splenic access is of interest because it avoids damage to the liver graft. However, the spleen cannot be punctured to access the portal vein after splenectomy. We herein report a case of portal vein thrombosis following living donor liver transplantation with simultaneous splenectomy successfully treated by percutaneous intervention with direct puncture of the retropancreatic splenic vein. The splenic vein was punctured under computed tomography guidance in the prone position. Portal venography revealed a contrast defect due to a thrombus in the extrahepatic to intrahepatic portal vein. The portal vein was reopened after thrombectomy, and the portal vein thrombosis did not recur for 2 y. The technique and advantages of our approach are described.