Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Intervention Radiology, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ann Surg. 2022 Dec 1;276(6):e834-e841. doi: 10.1097/SLA.0000000000004868. Epub 2021 Mar 29.
The aim of the present study is to evaluate efficacy and safety of proximal splenic vein embolization (PSVE) for liver transplant recipients having complicated large splenorenal shunts (SRS).
In adult living donor liver transplantation for a patient who has large splenorenal shunts (SRS), their interruption is utmost important to maintain adequate portal flow by avoidance of portal flow steal through the preexisting SRS. We effectively managed most of the recipients with surgical ligation and/or additional radiologic embolization using by intraoperative cine-portogram. However, when complete interruption is not achieved in a few recipients having complicated large SRS, it may leave a chance of lethal portal flow steal in the recipient afterward.
PSVE was performed in 13 patients between April 2014 and November 2017. We performed a retrospective analysis of preoperative images, postoperative graft and recipient outcomes, and presence of isolated portal hypertension.
Ten patients underwent PSVE as an additional secondary method because of portal steal syndrome through the remaining SRS after surgical interruption and/or embolization, and 3 patients underwent PSVE only as a primary method of SRS interruption. In all 13 patients, portal steal on the final intraoperative cine-portogram completely disappeared after PSVE. All patients recovered with satisfactory regeneration of the partial liver graft without the reappearance of portosystemic collaterals, and there were no procedure-related complications.
PSVE is an effective and safe procedure to secure adequate portal flow without portal steal for patients with complicated large SRS arising from multiple sites of the splenic vein or escaping to multiple terminal ends.
本研究旨在评估经皮脾脏近端静脉栓塞（PSVE）治疗伴有复杂大脾肾分流（SRS）的肝移植受者的疗效和安全性。
在成人活体供肝移植中，对于存在大脾肾分流（SRS）的患者，为避免通过预先存在的 SRS 发生门脉血流窃流，中断 SRS 极为重要。我们通过术中电影门静脉造影有效地对大多数患者进行了手术结扎和/或额外的放射栓塞治疗。然而，对于少数伴有复杂大 SRS 的患者，如果不能完全中断 SRS，可能会在受者中留下致命性门脉血流窃流的机会。
2014 年 4 月至 2017 年 11 月期间，我们对 13 例患者进行了 PSVE。我们对术前图像、术后移植物和受者结局以及孤立性门静脉高压的存在进行了回顾性分析。
10 例患者因手术中断和/或栓塞后剩余 SRS 发生门脉窃流综合征而行 PSVE 作为辅助的二级治疗方法，3 例患者仅因 SRS 中断而行 PSVE 作为一级治疗方法。在所有 13 例患者中，PSVE 后最终术中电影门静脉造影上的门脉窃流完全消失。所有患者均恢复良好，部分肝移植再生，门体侧支循环无再发，无与手术相关的并发症。
PSVE 是一种有效且安全的方法，可确保复杂大 SRS 患者（来自多个脾脏静脉部位或分流至多个末端）获得足够的门脉血流而无门脉窃流。
