DONOR ILIAC VEIN INTERPOSITION DURING LIVER-TRANSPLANTATION IN A PATIENT WITH A MIGRATED TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT

Background. Transjugular intrahepatic portosystemic shunts (TIPS) are sometimes used to reduce the risk of variceal bleeding or treat intrac table ascites before orthotopic liver transplantation (OLT). TIPS usua lly do not make OLT more difficult, but rarely, malposition of TIPS ca n significantly complicate OLT. Methods and Results. The following rep ort describes a patient in whom an initially well-placed Wallstent mig rated to the confluence of the splenic and superior mesenteric veins. During liver transplantation, the portal vein containing the Wallstent was completely resected, and the portal vein was reconstructed with d onor iliac vein. After sewing the iliac vein onto the portal remnant, the liver transplant was completed under portosystemic bypass. The pat ient had an uneventful recovery. Conclusions. Wallstents can migrate w ithin the portal vein. An interposition graft of donor vein allows ful l resection of the portal vein containing a migrated stent and facilit ates portosystemic bypass and portal anastomosis.