RT Book, Section A1 McCormack, Lucas A1 Devoto, Jorge A2 Molmenti, Ernesto Pompeo A2 Santibañes, Martin de A2 Santibañes, Eduardo de SR Print(0) ID 1180112916 T1 Portal Vein Thrombosis T2 Liver Transplantation: Operative Techniques and Medical Management YR 2021 FD 2021 PB McGraw Hill PP New York, NY SN 9781260462517 LK accesssurgery.mhmedical.com/content.aspx?aid=1180112916 RD 2024/03/29 AB Although the surgical technique of liver transplantation (LT) has emerged from an experimental therapy to a more standardized and relatively safe procedure, great differences exist in the complexity of the operation among different patients. Venous abnormalities are a relatively frequent finding. These abnormalities include acute and chronic portal vein thrombosis (PVT). The incidence of PVT in patients undergoing orthotopic liver transplantation (OLT) ranges from 2.1% to 26% in a large reported series. During LT, it may be difficult to reconstitute adequate portal venous inflow to the graft in these patients. In the 1980s, PVT was considered an absolute contraindication to OLT. In 2000, Yerdel et al. proposed a grading system for PVT (Table 73-1, Fig. 73-1). Grade 1 involves less than 50% of the portal vein (PV) lumen with or without minimal extension into the superior mesenteric vein (SMV) (Fig. 73-2). With grade 2, more than 50% occlusion of the PV is present, including total occlusion, with or without minimal extension into the SMV (Fig. 73-3). Grade 3 involves complete thrombosis of both the PV and the SMV trunk (distal SMV patent) (Fig. 73-4). Grade 4 involves complete thrombosis of both the PV and SMV (Fig. 73-5). Several surgical techniques have been described to deal with portal or mesenteric vein thrombosis.1–3