In Reply to: Case 1001-03 -- Recanalization of Thrombosed Portal Vein in Transplanted Liver posted by Editor on October 04, 2001 at 12:05:35:
We have done something similar once, several years back--lysed an acute portal vein thrombus in a child after successful portal venoplasty. In this instance, heparin was not started after PTA and the portal vein thrombosed. Used 250K urokinase.
Regarding the questions: we don't primarily stent any lesion that looks this good after PTA although some may come back a few months later and need to be stented; we have used Wallstents but in this case, balloon expandable stent may be easier to position correctly; and we have not had to use TPA (so far). I would be hesitant about using lytics in the immediate post-transplant period but once the graft heals, bleeding is pretty unusual due to abundant scar that surrounds the transplant (we don't even embolize tracts with gelfoam anymore).
Beautiful result!