Maggi U, Camagni S, Reggiani P, Lauro R, Sposito C, Melada E, Rossi G
Unitá Operativa Chirurgia Generale e Trapianti di Fegato, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milano, Italy.
Transplant Proc. 2010 May;42(4):1369-74. doi: 10.1016/j.transproceed.2010.03.087.
Portal vein arterialization (PVA) is a salvage procedure for insufficient hepatic arterial or portal vascularization. It plays a role in auxiliary and orthotopic liver transplantation (OLT). In OLT, current indications for PVA include hepatic artery thrombosis (HAT), pre-OLT or post-OLT extended splanchnic vein thrombosis, intraoperative low portal flow, and anatomic variations like the absence of portal and mesenteric veins. Out of the transplantation domain, PVA is used both in extensive surgery for malignancies of the liver, biliary tract, and pancreas and in the treatment of fulminant hepatic failure (FHF) due to intoxications. We describe a case of acute post-OLT HAT successfully treated with PVA as a short bridge to retransplantation. By Doppler ultrasound of clinical PVA we detected an increased intrahepatic portal flow velocity, with disappearance of the arterial spikes, a finding that needs further investigation. PVA represents a rare surgical procedure. In fact, it has been used most of all in urgent conditions or in case of abrupt vascular complications during surgery. According to the literature, PVA emerges as a salvage procedure for poor arterial or portal hepatic flow, both in OLT and in general abdominal surgery. The outcome of this procedure is unpredictable. The aim of the shunt is to gain time, awaiting the onset of collateral arterial vessels or the performance of definitive surgery. Its early thrombosis may be a catastrophic event, due to acute liver ischemia. In contrast, a late occlusion is often well tolerated. Strict surveillance is always useful because sometimes it is mandatory to embolize the arterioportal fistula to treat or to prevent the onset of portal hypertension.
门静脉动脉化（PVA）是一种针对肝动脉或门静脉血运不足的挽救性手术。它在辅助性肝移植和原位肝移植（OLT）中发挥作用。在OLT中，目前PVA的适应证包括肝动脉血栓形成（HAT）、OLT术前或术后广泛性内脏静脉血栓形成、术中门静脉血流低以及门静脉和肠系膜静脉缺如等解剖变异。在移植领域之外，PVA既用于肝脏、胆道和胰腺恶性肿瘤的广泛手术，也用于中毒所致暴发性肝衰竭（FHF）的治疗。我们描述了一例OLT术后急性HAT患者，成功采用PVA作为再次移植的短期过渡桥梁。通过对临床PVA进行多普勒超声检查，我们检测到肝内门静脉血流速度增加，动脉波峰消失，这一发现需要进一步研究。PVA是一种罕见的外科手术。事实上，它大多用于紧急情况或手术期间突发血管并发症的情况。根据文献，PVA在OLT和普通腹部手术中均作为肝动脉或门静脉血流不佳的挽救性手术出现。该手术的结果不可预测。分流的目的是争取时间，等待侧支动脉血管形成或进行确定性手术。其早期血栓形成可能是灾难性事件，因为会导致急性肝缺血。相比之下，晚期闭塞通常耐受性良好。严格监测总是有用的，因为有时必须栓塞动门静脉瘘以治疗或预防门静脉高压的发生。
