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 Walser

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)279-283
Number of pages5
JournalCardioVascular and Interventional Radiology
Volume32
Issue number2
DOIs
StatePublished - Mar 2009
Externally publishedYes

Fingerprint

Venous Thrombosis
Pancreas
Transplants
Thrombectomy
Phlebography
Portal Vein
Allografts
Thrombosis
Tissue Donors
Iliac Vein
Mesenteric Veins
Pancreas Transplantation
Endovascular Procedures
Pancreatectomy
Graft Rejection
Graft Survival
Stents
Drainage
Pathologic Constriction
Necrosis

Keywords

  • Pancreas transplant
  • Venous stents
  • Venous thrombolysis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Stockland, A. H., Willingham, D. L., Paz-Fumagalli, R., Grewal, H. P., McKinney, J. M., Hughes, C. B., & Walser, E. (2009). Pancreas transplant venous thrombosis: Role of endovascular interventions for graft salvage. CardioVascular and Interventional Radiology, 32(2), 279-283. https://doi.org/10.1007/s00270-009-9507-9

Pancreas transplant venous thrombosis : Role of endovascular interventions for graft salvage. / Stockland, Andrew H.; Willingham, Darrin L.; Paz-Fumagalli, Ricardo; Grewal, Hani P.; McKinney, J. Mark; Hughes, Christopher B.; Walser, Eric.

In: CardioVascular and Interventional Radiology, Vol. 32, No. 2, 03.2009, p. 279-283.

Research output: Contribution to journalArticle

Stockland, AH, Willingham, DL, Paz-Fumagalli, R, Grewal, HP, McKinney, JM, Hughes, CB & Walser, E 2009, 'Pancreas transplant venous thrombosis: Role of endovascular interventions for graft salvage', CardioVascular and Interventional Radiology, vol. 32, no. 2, pp. 279-283. https://doi.org/10.1007/s00270-009-9507-9
Stockland, Andrew H. ; Willingham, Darrin L. ; Paz-Fumagalli, Ricardo ; Grewal, Hani P. ; McKinney, J. Mark ; Hughes, Christopher B. ; Walser, Eric. / Pancreas transplant venous thrombosis : Role of endovascular interventions for graft salvage. In: CardioVascular and Interventional Radiology. 2009 ; Vol. 32, No. 2. pp. 279-283.
@article{71b5f9eda8e6403e847998cb9215e897,
title = "Pancreas transplant venous thrombosis: Role of endovascular interventions for graft salvage",
abstract = "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.",
keywords = "Pancreas transplant, Venous stents, Venous thrombolysis",
author = "Stockland, {Andrew H.} and Willingham, {Darrin L.} and Ricardo Paz-Fumagalli and Grewal, {Hani P.} and McKinney, {J. Mark} and Hughes, {Christopher B.} and Eric Walser",
year = "2009",
month = "3",
doi = "10.1007/s00270-009-9507-9",
language = "English (US)",
volume = "32",
pages = "279--283",
journal = "CardioVascular and Interventional Radiology",
issn = "7415-5101",
publisher = "Springer Verlag",
number = "2",

}

TY - JOUR

T1 - Pancreas transplant venous thrombosis

T2 - Role of endovascular interventions for graft salvage

AU - Stockland, Andrew H.

AU - Willingham, Darrin L.

AU - Paz-Fumagalli, Ricardo

AU - Grewal, Hani P.

AU - McKinney, J. Mark

AU - Hughes, Christopher B.

AU - Walser, Eric

PY - 2009/3

Y1 - 2009/3

N2 - 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.

AB - 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.

KW - Pancreas transplant

KW - Venous stents

KW - Venous thrombolysis

UR - http://www.scopus.com/inward/record.url?scp=67649097109&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67649097109&partnerID=8YFLogxK

U2 - 10.1007/s00270-009-9507-9

DO - 10.1007/s00270-009-9507-9

M3 - Article

C2 - 19184193

AN - SCOPUS:67649097109

VL - 32

SP - 279

EP - 283

JO - CardioVascular and Interventional Radiology

JF - CardioVascular and Interventional Radiology

SN - 7415-5101

IS - 2

ER -