PMC5742012_01
Arrow showing Cavernous malformation of the portal vein.
gr1.jpg
PMC5742012_01_gr1.jpg
fig0005
Preoperative CT of his abdomen showed grade III PVT with cavernous malformation (Fig. 1).
Arrow showing spleno-renal shunt.
gr2.jpg
PMC5742012_01_gr2.jpg
fig0010
We reviewed his imaging carefully and there appeared to be a large spleno-renal shunt that was 10 mm in diameter (Fig. 2).
Duplex scan showing antegrade flow through spleno-renal shunt.
gr3.jpg
PMC5742012_01_gr3.jpg
fig0015
We then measured the flow through the spleno-renal shunt via duplex scan, which demonstrated an antegrade flow towards the renal vein with a velocity between 19.5 cm/sec and 40 cm/sec (Fig. 3).
Drawing showing donor iliac vein interposition graft anastomosis to the recipient left renal vein. Please note a Satisnky clamp should be applied for proximal control of the left renal vein, this was omitted from the drawing for a better view of the anastomosis.
gr4.jpg
PMC5742012_01_gr4.jpg
fig0020
The donor's iliac vein interposition graft was anastomosed to the recipient's left renal vein in an end-to-end fashion (Fig. 4). The donor's portal venous inflow was established by anastomosing the interposition graft to the donor portal vein (Fig. 5).
Intra-operative view of donor iliac vein interposition graft.
gr5.jpg
PMC5742012_01_gr5.jpg
fig0025
The donor's iliac vein interposition graft was anastomosed to the recipient's left renal vein in an end-to-end fashion (Fig. 4). The donor's portal venous inflow was established by anastomosing the interposition graft to the donor portal vein (Fig. 5).
Post-operative CT showing reno-portal anastomosis.
gr6.jpg
PMC5742012_01_gr6.jpg
fig0030
Post- operative liver CT showed patent reno-portal anastomosis (Fig. 6).
PMC5742012_02
Arrow pointing to portal vein thrombosis with diminutive portal vein. Patent communication between SMV and splenic vein.
gr7.jpg
PMC5742012_02_gr7.jpg
fig0035
Preoperative triple phase CT of the liver showed diminutive recipient portal vein with PVT (Fig. 7). Reviewing the preoperative CT, there was good communication between the superior mesenteric vein (SMV) and splenic vein indicating good splanchnic drainage through a spleno-renal shunt (Fig. 7).
Large spleno-renal shunt measuring 12.6 mm.
gr8.jpg
PMC5742012_02_gr8.jpg
fig0040
The spleno-renal shunt was also large at 12.6 mm (Fig. 8).