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Preemptive VAE-An Important Tool for Managing Blood Loss in MVT Candidates With PMT
Deeplaxmi P Borle1, Samuel J Kesseli1, Andrew S Barbas1
1Department of Surgery, Duke University Hospital, Durham, NC.
Transplantation Direct
|June 9, 2021
Summary
Preoperative visceral angioembolization reduced blood loss in multivisceral transplant patients with portomesenteric thrombosis. However, potential consequences of native organ ischemia require further investigation.
Area of Science:
- Transplant Surgery
- Vascular Surgery
- Interventional Radiology
Background:
- Multivisceral transplant candidates with extensive portomesenteric thrombosis (PMT) face high morbidity during native viscera explantation due to vascularized adhesions.
- Preemptive visceral angioembolization is a technique to minimize blood loss, but its efficacy in extensive PMT cases is not well-documented.
Purpose of the Study:
- To evaluate the effectiveness of preoperative visceral angioembolization in reducing blood loss during multivisceral transplant explantation in patients with extensive portomesenteric thrombosis.
Main Methods:
- A series of 5 patients with PMT underwent preoperative embolization of the superior mesenteric, splenic, and hepatic arteries.
- Blood loss, blood product utilization, and 30-day infectious complications were assessed post-embolization and explantation.
Main Results:
- Median blood loss was 6000 mL, with significant transfusion requirements (median 16 units PRBCs, 14 units FFP).
- Postoperative complications included infectious complications in 3/5 patients and graft pancreatitis in 2/5, leading to one mortality.
- Significant blood loss and transfusion needs were observed despite embolization.
Conclusions:
- Preoperative embolization can mitigate exsanguinating blood loss in multivisceral transplant for PMT.
- The clinical significance of native organ ischemia resulting from embolization remains uncertain and warrants further study.
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