Liver transplantation with calcific sclerosis of the portal vein

Thrombosis or phlebosclerosis of the portal vein is an infrequent finding during the preoperative evaluation of a potential liver transplant recipient. Occasionally the process extends proximally into the superior mesenteric vein. This precludes conventional methods of portal venous reconstruction, necessitating reconstitution of portal venous inflow during liver transplantation through a venous conduit. The authors present a case of calcific phlebosclerosis of the portal and distal superior mesenteric veins that was delineated during preoperative imaging. This case emphasizes the importance of visualizing both the portal and superior mesenteric veins during the preoperative assessment, when patency of the portal vein is questionable. When the obliterative process extends into the distal superior mesenteric vein the authors recommend construction of the venous conduit from the proximal superior mesenteric vein as a pre-emptive manoeuvre before dissection of the recipient's liver and hilar structures. The venous conduit is then ready for immediate use during engraftment, thereby maintaining the shortest possible anhepatic time.