Visceral arterial embolization prior to multivisceral transplantation in recipient with cirrhosis, extensive portomesenteric thrombosis, and hostile abdomen: Performance and outcome analysis

Autor:	Ramona Nicolau-Raducu, Rodrigo Vianna, Thiago Beduschi, Yehuda Raveh, Gennaro Selvaggi, Jason Salsamendi, Akin Tekin, Joshua Livingstone
Rok vydání:	2019
Předmět:	Adult Liver Cirrhosis Male medicine.medical_specialty medicine.medical_treatment Ischemia 030230 surgery Gastroduodenal artery 03 medical and health sciences 0302 clinical medicine medicine.artery Abdomen medicine Humans Embolization Disseminated intravascular coagulation Venous Thrombosis Transplantation business.industry Portal Vein Arterial Embolization Angiography Organ Transplantation Middle Aged medicine.disease Prognosis Thrombosis Embolization Therapeutic Transplant Recipients Portal vein thrombosis Surgery Viscera 030211 gastroenterology & hepatology business
Zdroj:	Clinical transplantation. 33(8)
ISSN:	1399-0012
Popis:	Multivisceral transplant (MVT) for cirrhosis, and portomesenteric vein thrombosis (PVT), is fraught with life-threatening thrombo-hemorrhagic complications. Embolization of native viscera has been attempted in a handful of cases with mixed results. We carried out a comparative analysis of angiographic, intra-operative, and pathological findings in three recipients of MVT who were deemed exceptionally high hemorrhagic risk and therefore underwent preoperative visceral embolization. All recipients were male with cirrhosis, PVT, and a surgical history indicative of diffuse visceral adhesions; status post-liver transplantation (n = 2) and proctocolectomy (n = 1). The first patient had two Amplatzer II embolization plugs placed 2 cm from the origins of celiac and superior mesenteric (SMA) arteries. Distal migration of the celiac plug into gastroduodenal artery (GDA) and ensuing ischemia reperfusion injury, presumably contributed to severe disseminated intravascular coagulation (DIC) and intra-operative mortality. In the other two recipients, distal Gelfoam embolization of the SMA, GDA, and splenic arteries was performed, and although remarkable hemorrhage and coagulopathy occurred, embolization, undoubtedly, facilitated exenteration and improved outcomes. Pathologic examination in these cases confirmed ischemic necrosis of eviscerated bowel. In conclusion, liver-sparing, preoperative distal embolization of native viscera with Gelfoam is beneficial, but entails several pitfalls. It should currently be reserved for MVT recipients who otherwise are at unacceptably high risk.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0d9fd172259c8279a8bba0eaf51e8a5f https://pubmed.ncbi.nlm.nih.gov/31230385 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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