CardioVascular and Interventional Radiology

, Volume 32, Issue 2, pp 279–283 | Cite as

Pancreas Transplant Venous Thrombosis: Role of Endovascular Interventions for Graft Salvage

  • Andrew H. Stockland
  • Darrin L. Willingham
  • Ricardo Paz-Fumagalli
  • Hani P. Grewal
  • J. Mark McKinney
  • Christopher B. Hughes
  • Eric M. WalserEmail author
Clinical Investigation


Venous thrombosis of pancreas transplant allografts often leads to graft loss. We evaluated the efficacy of emergent endovascular techniques to salvage thrombosed pancreatic allografts in a series of six patients. Of the 76 pancreas transplants performed between 2002 and 2006, six patients were diagnosed with venous thrombosis on MRI between 2 and 28 days posttransplant (mean, 9 days). Five patients were systemic-enteric (donor portal vein anastomosis to recipient iliac vein) and one patient was portal-enteric (donor portal vein anastomosis to recipient superior mesenteric vein). Conventional venography confirmed the diagnosis of venous thrombosis in all patients. One patient was treated with catheter-directed venous thrombolysis and balloon thrombectomy. Another patient was treated with rheolytic thrombectomy alone. The remaining four patients were treated with a combination of these mechanical and thrombolytic techniques. Completion venography revealed >50% clot reduction and resumption of venous drainage in all patients. One patient required additional intervention 16 days later for recurrent thrombosis. Two patients required metal stent placement for anastomotic stenoses or kinks. One patient required pancreatectomy 36 h after attempted salvage secondary to a major hemorrhage and graft necrosis. Two patients recovered pancreatic function initially but lost graft function at 8 and 14 months, respectively, from severe chronic rejection. Patient survival was 100%, long-term graft survival was 50%, rethrombosis rate was 16.6%, and graft loss from rejection was 33%. In conclusion, early recognition and treatment of venous thrombosis after pancreas transplantation has acceptable morbidity and no mortality using short-term endovascular pharmacomechanical therapy.


Pancreas transplant Venous thrombolysis Venous stents 


  1. 1.
    Humar A, Kandaswamy R, Granger D et al (2000) Decreased surgical risks of pancreas transplantation in the modern era. Ann Surg 231:269PubMedCrossRefGoogle Scholar
  2. 2.
    Gruessner A, for the American Society of Transplant Physicians Kidney-Pancreas Committee (1995) 14th Annual Meeting of the American Society of Transplant Physicians, May 1995Google Scholar
  3. 3.
    Troppman C, Gruessner AC, Benedetti E et al (1996) Vascular graft thrombosis after pancreatic transplantation: univariate and multivariate operative and nonoperative risk factor analysis. J Am Coll Surg 182:285Google Scholar
  4. 4.
    Douzdjian V, Abeccasis MM, Cooper JL et al (1993) Pancreas transplant salvage after acute venous thrombosis. Transplantation 6:222CrossRefGoogle Scholar
  5. 5.
    Fernandez-Cruz L, Gilabert R, Sabater L et al (1993) Pancreas graft thrombosis: prompt diagnosis and immediate thrombectomy or retransplantation. Clin Transplant 7:230–234Google Scholar
  6. 6.
    Allie DE, Herbert CJ, Khan MH et al (2003) The power pulse spray technique. Endovasc Today 2:25–30Google Scholar
  7. 7.
    The IPTR annual report 2004. Available at: Accessed February 1, 2008
  8. 8.
    Drachenberg DB, Papadimitriou JC, Farney A et al (2001) Pancreas transplantation: the histologic morphology of graft loss and clinical correlations. Transplantation 71(12):1784–1791PubMedCrossRefGoogle Scholar
  9. 9.
    Kessler L, Wiesel ML, Boudjema K et al (1998) Possible involvement of Von Willebrand factor in pancreatic graft thrombosis after kidney-pancreas transplantation: a retrospective study. Clin Transplant 12(1):35–42PubMedGoogle Scholar
  10. 10.
    Wright FH, Wright C, Ames SA et al (1980) Pancreatic allograft thrombosis: donor and retrieval factors and early postperfusion graft function. Transplant Proc 22:439Google Scholar
  11. 11.
    Hopt UT, Busing M, Schareck W et al (1993) Prevention of early postoperative graft thrombosis in pancreatic transplantation. Transplant Proc 25:2607PubMedGoogle Scholar
  12. 12.
    Jiminez C, Manrique A, Herrero ML et al (2005) Incidence of pancreas graft thrombosis in portoiliac and portocaval venous anastomosis. Transplant Proc 37:3977–3978CrossRefGoogle Scholar
  13. 13.
    Tollemar J, Tyden G, Brattstrom C et al (1988) Anticoagulation therapy for prevention of pancreatic graft thrombosis: benefits and risks. Transplant Proc 3:479Google Scholar
  14. 14.
    Osaki CF, Stratta R, Taylor RJ et al (1992) Surgical complications in solitary pancreas and combined pancreas-kidney transplantations. Am J Surg 164:546CrossRefGoogle Scholar
  15. 15.
    Sollinger HW (1996) Pancreatic transplantation and vascular graft thrombosis. J Am Coll Surg 182:362PubMedGoogle Scholar
  16. 16.
    Dafoe DC, Ratner LE (2005) Pancreatico-renal composite transplant: a new technique designed to decrease pancreatic graft thrombosis. Clin Transplant 19(5):690–693PubMedCrossRefGoogle Scholar
  17. 17.
    Calne RY, McMaster P, Rolles K et al (1981) Technical observations in segmental pancreas allografting: observations on pancreatic blood flow. In: Traeger J, Dubernard J (eds) Transplantation of the pancreas. Grune and Statton, New York, pp 51–59Google Scholar
  18. 18.
    Garvin PJ, Castaneda MA, Niehoff ML et al (1985) An in situ evaluation of distal splenic arteriovenous fistula on pancreas function in an isolated pancreas segment. Arch Surg 120:1148PubMedGoogle Scholar
  19. 19.
    Dafoe DC, Campbell DA Jr, Marks WH et al (1985) Association of inclusion of the donor spleen in pancreaticoduodenal transplantation with rejection. Transplantation 40:579PubMedCrossRefGoogle Scholar
  20. 20.
    Dafoe DC, Campbell DA Jr, Marks WH et al (1986) The effect of irradiation of the donor spleen on rejection of porcine pancreatico-duodenosplenic allografts. Transplantation 42:686PubMedCrossRefGoogle Scholar
  21. 21.
    Ciancio G, Cespedes M, Olson L et al (2000) Partial venous thrombosis of the pancreatic allograft after simultaneous pancreas-kidney transplantation. Clin Transplant 14(5):464–471PubMedCrossRefGoogle Scholar
  22. 22.
    Sansalone CV, Aseni P, Follini ML et al (1998) Early pancreas retransplantation for vascular thrombosis in simultaneous pancreas-kidney transplants. Transplant Proc 30:253–254PubMedCrossRefGoogle Scholar
  23. 23.
    MacMillan N, Fernandez-Cruz L, Ricart MJ (1998) Venous graft thrombosis in clinical pancreas transplantation: options for a rescue treatment. Transplant Proc 30(2):425–426PubMedCrossRefGoogle Scholar
  24. 24.
    Gilabert R, Fernandez-Cruz L, Real MI et al (2002) Treatment and outcome of pancreatic venous graft thrombosis after kidney-pancreas transplantation. Br J Surg 89(3):355–360PubMedCrossRefGoogle Scholar
  25. 25.
    Mahanty HD, Posselt AM, Lipshutz GS et al (2007) Catheter-directed therapy for DVT after pancreas transplantation. Clin Transplant 21(6):748–754PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Andrew H. Stockland
    • 1
  • Darrin L. Willingham
    • 2
  • Ricardo Paz-Fumagalli
    • 1
  • Hani P. Grewal
    • 2
  • J. Mark McKinney
    • 1
  • Christopher B. Hughes
    • 2
  • Eric M. Walser
    • 1
    Email author
  1. 1.Department of RadiologyMayo ClinicJacksonvilleUSA
  2. 2.Department of TransplantationMayo ClinicJacksonvilleUSA

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