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Portal Venous Thrombosis or Sclerosis in Liver Transplantation Candidates: Preoperative CT Findings and Correlation with Surgical Procedure¹

¹ From the Departments of Radiology (G.B., M.P.F., K.P.) and Surgery (D.A.G.), University of Pittsburgh Medical Center, Presbyterian Hospital, Rm 4660, 200 Lothrop St, Pittsburgh, PA 15213-2582. Received October 6, 2000; revision requested November 16; revision received January 29, 2001; accepted February 26. G.B. supported by the Nicholas Green Fulbright Grant. Address correspondence to M.P.F. (e-mail: federle@pitt.edu).

PURPOSE: To review computed tomographic (CT) findings in patients with surgically proved portal venous (PV) thrombosis or sclerosis and to correlate these findings with the surgical procedure used at orthotopic liver transplantation (OLT).

MATERIALS AND METHODS: Among 379 OLTs, PV thrombosis or sclerosis was found at surgery in 39 patients (10.3%). Before OLT, surgical records and CT images were retrospectively reviewed in 35 patients with available CT studies. Diameter of the extrahepatic PV and patency of the PV system were evaluated. Cavernous transformation, calcifications of the venous wall or thrombus, lesions suggestive of tumor, mesenteric varices, edema, or splenorenal shunt were recorded. A nonpaired Student t test and the Fisher exact test were used to analyze the results.

RESULTS: Of 35 patients, 23 (66%) underwent thrombectomy with direct PV-to-PV anastomosis and 12 (34%) had placement of venous grafts or other anastomoses. The extrahepatic PV was 8.2 mm, but it significantly (P .05) decreased in patients with splenorenal shunt. In 30 patients, CT depicted thrombosis, PV calcification, or other abnormalities. The thrombus extended to or beyond the confluence of the splenic and superior mesenteric veins in 21 (60%) and 11 (31%) patients, respectively. Eleven patients (31%) had cavernous transformation of the PV; eight (23%), a cordlike sclerotic PV; 19 (54%), a splenorenal shunt; 11 (31%), PV calcification; 17 (49%), mesenteric edema; 14 (40%), mesenteric varices. Patients with a cordlike or calcified PV were significantly (P .05) more likely to require modification of the surgical technique.

CONCLUSION: Before OLT, CT can aid in assessment of PV and associated findings and in surgical management.

Index terms: Liver, transplantation, 761.455 • Portal vein, CT, 957.12912, 957.12915 • Portal vein, thrombosis, 957.751

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