Patients receiving liver transplantation in a setting of complete portal vein (PV) and superior mesenteric vein (SMV) thrombosis (Yerdel grade 4) experience lower outcomes after surgery; prognosis is independently influenced by the portal flow reconstruction technique, showing better outcomes in physiological surgical strategies. We describe a case of living donor liver transplantation in which the patient could not receive common physiological reconstructions preoperatively due to multiple small collaterals and extensive thrombosis down to first branches of SMV. We performed thromboendovenectomy of the PV and SMV first, but acute thrombosis developed recurrently even with interposition venous homograft between pericholedochal collateral vein and proximal recipient PV. Immediate after surgery, an intervention radiologist performed stent insertion into 3 stenotic points. Through multidisciplinary approach, complete physiological recanalization was obtained with normal liver function.

中文翻译：

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活体供体肝移植中独特的多学科方法，在门静脉系统完全闭塞合并慢性和亚急性血栓形成的患者中实现完全生理血运重建


在完全门静脉 （PV） 和肠系膜上静脉 （SMV） 血栓形成（Yerdel 4 级）情况下接受肝移植的患者术后预后较低;预后受门静脉血流重建技术独立影响，在生理手术策略中显示出更好的结果。我们描述了一例活体供体肝移植病例，其中由于多个小侧支和广泛的血栓形成直至 SMV 的第一分支，患者在术前无法接受常见的生理重建。我们首先对 PV 和 SMV 进行了血栓静脉内切除术，但即使在胆管周围侧支静脉和近端受者 PV 之间插入静脉同种移植物，急性血栓形成也会反复发生。手术后，干预放射科医生立即将支架插入 3 个狭窄点。通过多学科方法，在肝功能正常的情况下获得完全的生理再通。