Current perspectives on preoperative diagnosis and surgical management of portal vein thrombosis in patients requiring liver transplantation

• Main Author: CHEN Kai
• Format: Article
• Language: zho
• Published: Editorial Department of Journal of Clinical Hepatology 2013-04-01
• Series: Linchuang Gandanbing Zazhi
• Subjects: vein thrombolism; portal vein; liver transplantation
• Online Access: http://www.lcgdbzz.org/qk_content.asp?id=5313&ClassID=31291455
• ISSN: 1001-5256; 1001-5256

Portal vein thrombosis (PVT) and portal vein tumor thrombosis (PVTT) are common contraindications for liver transplantation. While portal vein embolization has shown remarkable success in managing both contraindications, hepatocellular carcinoma-a frequent cause of PVTT-remains an absolute contraindication for liver transplantation. Therefore, it is not only crucial to diagnose PVT or PVTT preoperatively but also to determine the underlying etiology of the complication. This article summarizes the known etiologies and the various classification and grading systems of PVT, as well as the features and benefits of the established preoperative diagnostic methods for PVT and PVTT, including color Doppler ultrasound, computed tomography (CT), magnetic resonance imaging, digital subtraction angiography, and positron emission tomography-CT. Finally, the various management procedures available for treatment of PVT, including venous thrombectomy, vein bypass/interposition grafting, vein arterialization, cavoportal hemitransposition, and liver/small bowel co-transplantation, are discussed along with published results of patient outcome and limitations yet to be overcome. Obtaining a comprehensive evaluation and accurate preoperative diagnosis of the portal venous system, and having an understanding of the various surgical approaches for managing PVT, will promote the chances of successful patient outcome.