Endovascular balloon occlusion during reconstruction of portal vein injury

Abstract

Purpose

Repair of portal vein injury in a hostile abdomen can be very challenging, complicated by massive hemorrhage or stenosis. It can seldom be successfully carried out, even by experienced hepatobiliary surgeons. The ideal venous clamping technique is often not feasible and increases the risk of lethal portal vein laceration. The common mistake being the forceful use of clamps around the vein in the attempt to obtain vascular control, resulting in additional injuries.

Methods

We provide a descriptive report of two cases detailing a careful step-by-step technique for the management of portal vein injury by inserting an endovascular balloon inflated with serum to control bleeding and repair the vein.

Results

In patients who required this technique, no bleeding recurrence, nor portal vein thrombosis or stenosis was detected by CT-scan during follow-up.

Conclusion

The endovascular balloon occlusion technique for the reconstruction of portal vein injuries in hostile abdomen is a safe and life-saving procedure that should be part of the armamentarium of visceral surgeons.

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Abbreviations

HPB:

Hepatopancreaticobiliary

CT:

Computed tomography

SMV:

Superior mesenteric vein

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Acknowledgments

We thank Jacqueline Butterworth for manuscript editing.

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Authors

Contributions

All authors declare having sufficiently participated in the work to take public responsibility for appropriate portions of the content, as defined in the guidelines of the International Committee of Medical Journal Editors (ICMJE). A.H., R.S., F.P., and F.N. were responsible for study concept and design and contributed to acquisition and interpretation of data. A.H. and R.S. drafted the manuscript. F.P. and F.N. contributed to critical revision. All the authors have viewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Regis Souche.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and later amendments or comparable ethical standards. For retrospective studies in France, ethical approval is not systematically required. In our department, all patients signed a non-opposition form for the use of their specimen/clinical data.

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A non-opposition form was obtained from all individual participants included in the study.

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Herrero, A., Souche, R., Panaro, F. et al. Endovascular balloon occlusion during reconstruction of portal vein injury. Langenbecks Arch Surg 405, 391–395 (2020). https://doi.org/10.1007/s00423-020-01886-z

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Keywords

  • Hepatic
  • Pancreas
  • Patient safety
  • Endovascular technique