PMC4346461_01
Triphasic CT portal phase showing a thrombus in the main and left portal vein (arrow) and opacified segmental branches.
ijotm-6-033-g001.jpg
PMC4346461_01_ijotm-6-033-g001.jpg
F1
On the fourth post-operative day, thrombosis of the portal vein was detected by routine duplex ultrasonography and confirmed by CT (Fig 1).
IOUS image showing sluggish flow in the portal vein by B mode, stenosis at the origin of the left hepatic vein (short arrow) and residual proximal thrombus in the portal vein extending to the superior mesenteric and splenic veins.
ijotm-6-033-g002.jpg
PMC4346461_01_ijotm-6-033-g002.jpg
F2
The second was a remaining thrombus at the confluence of the superior mesenteric vein and splenic vein (Fig 2). The first step was to correct the stenosis by placing a venous patch from great saphenous vein.
Drawing showing the vein patch at the origin of the left portal vein
ijotm-6-033-g003.jpg
PMC4346461_01_ijotm-6-033-g003.jpg
F3
The 5-0 continuous polypropylene sutures from the initial right donor hepatectomy surgery was cut and the currently opened right portal vein ostium was closed with an elliptical patch using a valveless reversed saphenous vein segment (Fig 3).
IOUS images showing the balloon of Foley catheter (black arrow) in superior mesenteric vein with residual thrombus in the splenic vein.
ijotm-6-033-g004.jpg
PMC4346461_01_ijotm-6-033-g004.jpg
F4
We used a size 16 French Foley catheter for the thrombectomy via the initial 3-mm venotomy and inflated it with 3 mL of saline to avoid rupture the vein from over inflation (Fig. 4), using the same thrombectomy principles mentioned above.
IOUS image: axial section in the splenic vein showing residual thrombus and the tip of the inferior mesenteric vein catheter in thrombus (arrows)
ijotm-6-033-g005.jpg
PMC4346461_01_ijotm-6-033-g005.jpg
F5
The other end of the catheter was brought out of the abdominal wall (Fig 5).
PMC4346461_02