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- W2000501962 abstract "The Brief Communication by Neelamekam et al. (1) is an interesting report of how they treated a case of extensive portal and mesenteric vein thrombosis in liver transplantation. The authors describe a method of using the recipient splenic vein as a conduit to create a portal venous graft for the liver graft. Because of low portal inflow, they arterialized the conduit by an end-to-side anastomosis with the hepatic artery. In the follow-up period, portal hypertension occurred and the arterialization had to be disrupted by re-operation and ligation. The further course of the patient was uneventful, as the authors stated. From our point of view, a lot of questions remain to be answered. What about an angiogram as a routine procedure during the patient's evaluation? If not, why did the authors not try to improve the portal flow by ligation or dissection of the collateral blood flow into the varices? Did the authors control the portal flow during the operation? How did they evaluate the perfusion after the transplantation? By angiography or by duplex doppler? How did they decide to achieve enough portal flow during the second operation? In 1995, we reported three cases of total arterialization of the portal vein (2). Interestingly, we did not see any sign of portal hypertension in our cases, in two of them more than 3 years after the procedure. We tapered the flow through the arterialized portal vein by the width of the anastomosis. We drained the preexisting portal hypertension in one of our cases initially by a mesentericocaval shunt, which was very effective. Finally, we did not realize any portal hypertension, even in the long-term run of our patients. We fear only the imminent problem of aneurysm of the portal trunk in the hilum of the liver. We emphasize today, as we stated in our article, that arterialization of the portal vein of the liver graft should be performed only in life-threatening situations. Jochen Erhard1 Reinhard Lange Universitätsklinikum Essen; Zentrum für Chirurgie; Essen 45122, Germany" @default.
- W2000501962 created "2016-06-24" @default.
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- W2000501962 date "1997-11-01" @default.
- W2000501962 modified "2023-09-27" @default.
- W2000501962 title "Comment On ???Delayed Correction Of Portal Hypertension After Portal Vein Conduit Arterialization In Liver Transplantation??? By Neelamekam Et Al." @default.
- W2000501962 cites W1967282847 @default.
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- W2000501962 doi "https://doi.org/10.1097/00007890-199711270-00026" @default.
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