https://pubmed.ncbi.nlm.nih.gov/33232561/ Budd-Chiari syndrome

Case Reports

Pediatr Transplant. 2020 Nov 24;e13857.
doi: 10.1111/petr.13857.Online ahead of print.

Preoperative successful thrombectomy and thrombolysis of acute extensive splanchnic venous system and TIPSS thrombosis in a child with Budd-Chiari syndrome-Creating a window to enable living donor liver transplantation
Amey Sonavane 1, Vikram Raut 2, Shaji Marar 3, Ambreen Sawant 4, Ketul Shah 2, Amruth Raj 2, Ashok Thorat 2, Harshit Chaksota 4, Abhijit Bagde 5, Rahul Verma 5, Dhanya Dharmapalan 5, Suresh Vasanth 4, Aabha Nagral 1, Darius Mirza 2, Vijay Yewale 5 6

Abstract

Preoperative extensive PV thrombosis can pose a technical challenge during liver transplantation surgery. Several strategies adopted to mitigate this problem include creation of a superior mesenteric vein-PV jump graft, use of a polytetrafluoroethylene graft, renoportal anastomosis, or cavoportal hemitransposition. Extensive and diffuse thrombosis of the splanchnic venous system may even necessitate multivisceral transplantation. We describe the case of a pediatric patient with Budd-Chiari syndrome and decompensated cirrhosis, who developed extensive thrombosis of the porto-spleno-mesenteric venous system prior to liver transplantation. We used a combination technique of thrombus aspiration by a novel trans-TIPPS approach followed by thrombolysis. Complete preoperative resolution of the extensive thrombosis was achieved. This allowed the creation of a brief window to enable planned LDLT. In prudently selected patients, performing an early mechanical and chemical thrombolysis of an extensive acute splanchnic venous thrombosis can thus help expedite a planned LDLT.