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. 2025 Mar 19;8(1):24.
doi: 10.1186/s42155-025-00525-2.

Portal vein reconstruction in iatrogenic portal vein ligation

Tony Rizk  1 , Derek Groskreutz  2 , Carl Forsberg  2 , Stephen Stringfellow  2 , Ricardo Yamada  2 , Marcelo Guimaraes  2 , Yara Younan  2 , Antony Gayed  2
Affiliations

Portal vein reconstruction in iatrogenic portal vein ligation

Tony Rizk et al. CVIR Endovasc. .

Abstract

Laparoscopic cholecystectomy for acute cholecystitis is one of the most performed surgeries and is generally regarded as a safe procedure with a low risk of complications. Vascular and biliary injuries are rare but have severe consequences. No systematic studies have been performed to delineate optimal treatment strategies in these scenarios, which are typically managed on a case-by-case basis. The present report describes a patient who underwent a laparoscopic cholecystectomy, complicated by common bile duct and main portal vein ligation, resulting in hepatic infarcts, perihepatic abscess, and portal hypertension with ascites and portomesenteric congestive enteropathy. This case focuses on management of this patient's vascular injury, which was successfully treated by endovascular portal venous reconstruction using trans-splenic and right internal jugular vein access.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Consent for publication: Consent for publication was obtained for every individual person’s data included in the study. Competing interests: The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
A Coronal CT of the abdomen demonstrates the site of portal vein ligation (black arrow) without distal filling of portal vein branches. B Coronal CT of the abdomen demonstrates patient splenic vein (black arrow) and superior mesenteric vein (black arrowhead)
Fig. 2
Fig. 2
Portomesenteric venogram through the splenic vein demonstrates patent SV, SMV, IMV, and absence of the PV. The cluster of surgical clips represents the site of PV ligation
Fig. 3
Fig. 3
CBCT demonstrates the spatial relationship between the trans-splenic catheter situated in the region proximal to the ligated portal vein (black arrow) and the catheter in the middle hepatic vein (black arrowhead)
Fig. 4
Fig. 4
Pre-stenting venogram following crossing from above and snaring through transplenic access site to create stable through-and-through access for angioplasty and stenting
Fig. 5
Fig. 5
Final venogram following angioplasty and stenting demonstrates patent PVR from the portomesenteric confluence to the IVC, with decompressed portal venous system
See this image and copyright information in PMC

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