Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 27, 2014; 6(8): 549-558
Published online Aug 27, 2014. doi: 10.4254/wjh.v6.i8.549
From portal to splanchnic venous thrombosis: What surgeons should bear in mind
Quirino Lai, Gabriele Spoletini, Rafael S Pinheiro, Fabio Melandro, Nicola Guglielmo, Jan Lerut
Quirino Lai, Jan Lerut, Starzl Unit of Abdominal Transplantation, University Hospitals Saint-Luc, Université Catholique Louvain, B-1200 Brussels, Belgium
Gabriele Spoletini, Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford OX3 7LE, United Kingdom
Rafael S Pinheiro, Department of Gastroenterology, University of São Paulo Medical School, 05508-070 São Paulo, Brazil
Fabio Melandro, Nicola Guglielmo, Department of General Surgery and Organ Transplantation, University Sapienza, Umberto I Hospital, 00186 Rome, Italy
Author contributions: Lai Q gave substantial contributions to conception and design of the research; all the authors wrote the article and revised it critically and gave the final approval of the version to be published.
Correspondence to: Quirino Lai, MD, Starzl Unit of Abdominal Transplantation, University Hospital Saint-Luc, Université Catholique Louvain, Avenue Hippocrate 10, B-1200 Brussels, Belgium.
Telephone: +32-2-7641401   Fax: +32-2-7649039
Received: October 20, 2013
Revised: February 9, 2014
Accepted: June 18, 2014
Published online: August 27, 2014

The present study aims to review the evolution of surgical management of portal (PVT) and splanchnic venous thrombosis (SVT) in the context of liver transplantation over the last 5 decades. PVT is more commonly managed by endovenous thrombectomy, while SVT requires more complex technical expedients. Several surgical techniques have been proposed, such as extensive eversion thrombectomy, anastomosis to collateral veins, reno-portal anastomosis, cavo-portal hemi-transposition, portal arterialization and combined liver-intestinal transplantation. In order to achieve satisfactory outcomes, careful planning of the surgical strategy is mandatory. The excellent results that are obtained nowadays confirm that, even extended, splanchnic thrombosis is no longer an absolute contraindication for liver transplantation. Patients with advanced portal thrombosis may preferentially be referred to specialized centres, in which complex vascular approaches and even multivisceral transplantation are performed.

Keywords: Liver transplantation, Portal vein thrombosis, Splanchnic vein thrombosis, Thrombectomy, Vascular graft, Spleno-renal shunt, Cavo-portal hemi-transposition, Portal vein arterialization, Intestinal transplantation, Multi-visceral transplant

Core tip: The present study aims to review the evolution of surgical management of portal and splanchnic venous thrombosis in the context of liver transplantation.