In Reply to: Re: Case 0100_06 -- Management of Acute Liver Failure in a Patient with Portal and Hepatic Vein Thrombosis posted by Grant Price on January 05, 19100 at 16:34:54:
there certainly may have been merit in attempting lytics after embo though prior to creating the shunt . however, the quickest method to re establish adequate pv flow would be to stent over residual thrombus after mechanical thrombectomy and embo. my experience with pv thrombosis in the setting of advanced liver disease is that those segments of the pv which initially contained clot should be stented anyway despite seemingly successful thrombectomy or rethrombosis is frequent. additionally , hepatoma is often co existant and constitutes much of the clot rendering it resistant to lysis. i must say ,however , that i don't have alot of experience with administering lytics in this senario. attempts to extract hv clot may likely be futile,especially if there is thrombus in the smaller peripheral branches.