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Case Reports
. 2024 Sep 24:29:e944851.
doi: 10.12659/AOT.944851.

Successful Interventional Therapy for Portal Vein Stenosis after Ex Vivo Liver Resection and Autotransplantation in End-Stage Hepatic Alveolar Echinococcosis with Cavernous Transformation

Yierfan Yilihaer  1 , Maolin Wang  1 , Tuerganaili Aji  1   2 , Yingmei Shao  1   2 , Ainiwaer Aikebaer  1 , Ahmad Mahmood  1
Affiliations
Case Reports

Successful Interventional Therapy for Portal Vein Stenosis after Ex Vivo Liver Resection and Autotransplantation in End-Stage Hepatic Alveolar Echinococcosis with Cavernous Transformation

Yierfan Yilihaer et al. Ann Transplant. .

Abstract

BACKGROUND End-stage hepatic alveolar echinococcosis (AE) can result in cavernous transformation of the portal vein (CTPV) due to extensive invasion of the portal vein. Ex vivo liver resection and autotransplantation (ELRA) is a new treatment option for patients with end-stage hepatic AE combined with CTPV. ELRA can achieve radical resection of HAE lesions and vascular reconstruction, and also effectively controls bleeding, particularly in cases involving multiple tortuous PV collaterals. Unfortunately, postoperative complications related to the portal vein can impede liver blood flow, thereby increasing the risk of portal hypertension and eventual failure of the transplanted liver if not promptly treated through appropriate medical interventions. CASE REPORT We report the case of a 31-year-old woman who underwent ELRA for end-stage hepatic AE combined with CTPV, and early postoperative portal vein anastomotic stenosis occurred. Stenting of the portal vein was performed after clarification of the stenotic segment by portal venography, followed by anticoagulation therapy and close ultrasound follow-up. After the operation, the patient's portal vein anastomosis widened and the blood flow into the liver returned to normal, avoiding graft liver failure. At 3-year follow-up, the portal vein stent was patent and no serious portal vein complications such as thrombosis had occurred. CONCLUSIONS ELRA provides a new therapeutic approach for patients with HAE combined with CTPV, and intraoperative portal vein reconstruction is one of the key procedures. For CTPV patients with early postoperative portal vein stenosis, interventional therapy (IVR) offers fresh perspectives and avoids acute liver failure caused by liver hypoperfusion.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
Preoperative and postoperative CT images of patients. (A) Lesion of hepatic AE. (B) The right branch of the portal vein was invaded by the AE lesion and portal vein occlusion has resulted in cavernous degeneration of the portal vein (the red arrow points to CTPV). (C) Vascular reconstruction in the portal vein phase.
Figure 2
Figure 2
Alterations in portal anastomotic diameter and blood flow velocity before and after Interventional radiology. (A) Alteration in anastomotic diameter before and after interventional therapy. (B) Alteration in velocity of portal vein flow before and after interventional therapy.
Figure 3
Figure 3
Ultrasound before and after portal vein stent placement. (A) Ultrasound images 5 days after surgery (before placement of portal vein stent). (B) Ultrasound images 7 days after surgery (after placement of portal vein stent).
Figure 4
Figure 4
Flow chart of the patient’s clinical course from diagnosis to IVR and follow-up.
See this image and copyright information in PMC

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References

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