Novel Hybrid Approach to Portal Vein Thrombectomy Immediately Prior to Orthotopic Liver Transplantation

Portal vein thrombosis (PVT) is common among liver transplant candidates, affecting up to 26% of patients awaiting liver transplant. Despite the suspected negative impact of PVT on liver transplant outcomes, consensus recommendations remain lacking. Thrombus circumvention is most commonly achieved with eversion portal thromboendovenectomy or venous jump graft. We present a novel hybrid approach addressing PVT in a patient with acute hepatic decompensation and worsening clot burden extending to the superior mesenteric and splenic veins. This patient underwent a transjugular intrahepatic portosystemic shunt (TIPS) placement and endovascular thrombectomy of the splanchnic veins less than 24 h prior to undergoing an orthotopic liver transplant with the graft maintained on normothermic machine perfusion. Three-month postoperative scans demonstrated a patent portal venous system with trace residual clot burden. This is the first reported case utilizing a hybrid approach for a portal vein thrombus extending into the superior mesenteric and splenic veins with subsequent orthotopic liver transplant.