Portal Vein Recan #Recandoit

Portal vein cavernoma is a serious consequence of portal vein thrombosis, and it is sometimes viewed as a contraindication for liver transplantation. Dr. Salem explains that recanalizing this occlusion can improve outcomes after transplantation because it makes the native portal vein intraoperatively usable for transplant surgeons.

Patients are usually referred to Dr. Salem through HCC tumor boards. He usually performs a full workup to ensure that patients are fully prepared for transplant, in case there is sudden liver decompensation. He also does high quality imaging with triple-phase CT, since it can show the exact vasculature of the splenic vein and intraparenchymal splenic venous system.

In the early days of portal vein recanalization, Dr. Salem would approach each case by gaining TIPS access. Nowadays, he prefers transsplenic access since it makes more anatomical sense to recanalize in the direction of the liver and it reduces the amount of procedural time. He encourages IRs to shed the mindset that splenic access has a prohibitively high bleeding risk. Dr. Salem describes the rest of the procedure, which includes puncturing the splenic vein, finding a remaining cord of the portal vein, puncturing the portal vein if needed, and recanalizing with a through-and-through technique and a TIPS. Throughout the episode, he shares pearls of wisdom for identifying the splenic vein, his preferred tools, and embolizing varices.

Finally, Dr. Salem describes his one month follow-up with cross-sectional imaging and ultrasound to check for varices, measure the diameter of the portal vein, and plan for future transplant.