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Application of Proximal Splenic Vein Embolization to Interrupt Complicated Large Splenorenal Shunts in Adult Living Donor Liver Transplantation

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Abstract
----------e-pub(22.1.12 현재)----------------

2021 Mar 29.
doi: 10.1097/SLA.0000000000004868. Online ahead of print.

Objective: The aim of present study is to evaluate efficacy and safety of proximal splenic vein embolization (PSVE) for liver transplant recipients having complicated large splenorenal shunts (SRS).

Background: In adult living donor liver transplantation (ALDLT) for a patient who has large splenorenal shunts (SRS), their interruption is utmost important to maintain adequate portal flow by avoidance of portal flow steal through the preexisting SRS. We effectively managed most of the recipients with surgical ligation and/or additional radiologic embolization using by intraoperative cine-portogram (IOP). However, when complete interruption is not achieved in a few recipients having complicated large SRS, it may leave a chance of lethal portal flow steal in the recipient afterwards.

Methods: PSVE was performed in 13 patients between April 2014 and November 2017. We performed a retrospective analysis of preoperative images, postoperative graft and recipient outcomes, and presence of isolated portal hypertension.

Results: Ten patients underwent PSVE as an additional secondary method because of for portal steal syndrome through the remaining SRS after surgical interruption and/or embolization, and 3 patients underwent PSVE only as a primary method of SRS interruption. In all 13 patients, portal steal on the final IOP completely disappeared after PSVE All patients recovered with satisfactory regeneration of the partial liver graft without the reappearance of portosystemic collaterals, and there were no procedure-related complications.

Conclusions: PSVE is an effective and safe procedure to secure adequate portal flow without portal steal for patients with complicated large SRS arising from multiple sites of the splenic vein or escaping to multiple terminal ends.
Author(s)
강우형고기영권동일문덕복윤영인이승규조휘동
Issued Date
2021
Type
Article
Keyword
Abridged Index Medicus
DOI
10.1097/SLA.0000000000004868
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8238
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2520872962&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Application%20of%20Proximal%20Splenic%20Vein%20Embolization%20to%20Interrupt%20Complicated%20Large%20%20Splenorenal%20Shunts%20in%20Adult%20Living%20Donor%20Liver%20Transplantation&offset=0&pcAvailability=true
Publisher
ANNALS OF SURGERY
Location
미국
Language
한국어
ISSN
0003-4932
Citation Volume
000
Citation Number
000
Citation Start Page
000
Citation End Page
000
Appears in Collections:
Medicine > Medicine
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