From portal to splanchnic venous thrombosis: What surgeons should bear in mind

Figure 1 Portal vein thrombosis classification according to Yerdel et al[3]. PV: Portal vein; SMV: Superior mesenteric vein.

Figure 2 Algorithm for the management of portal and splanchnic vein thrombosis during liver transplantation. CPHT: Cavo-portal hemitransposition; CPHT E-E: End-to-end cavo-portal hemitransposition; CPHT S-E: Side-to-end cavo-portal hemitransposition; ETEV: Eversion thromboendovenectomy; IVC: Inferior vena cava; MC: Mesocaval shunt (spontaneous or surgical); PV: Portal vein; PVT: Portal vein thrombosis; RPA: Reno-portal anastomosis; SMV: Superior mesenteric vein; SR: Splenorenal shunt (spontaneous or surgical); ST: Splanchnic tributary (coronary, gastroepiploic vein). From Paskonis et al[43], with modifications.

Figure 3 Eversion venous thrombectomy technique. A and B: Schematic representation of the manoeuvre; C: Intraoperative image of thrombectomy procedure; D: The thrombus removed from the portal vein. Modified from Lerut et al[13]. Figures from the experience of Prof. Jan Lerut.

Figure 4 Intraoperative image of a large coronary vein and a thrombosed portal vein. Figure from the experience of Prof. Jan Lerut.

Figure 5 Examples of different techniques of portal flow reconstruction during cavo-portal hemitransposition. A: End-to-end cavoportal anastomosis; B: Side-to-end cavoportal anastomosis with retro-hepatic caval vein constriction; C: End-to-side cavoportal anastomosis using vein interposition graft distal to the conventional portal vein anastomosis. Modified from Paskonis et al[43]. Figures from the experience of Prof. Jan Lerut.