PERCUTANEOUS RECANALIZATION OF ACUTE ARTERIAL THROMBOSIS IN POSTOPERATIVE OF MAJOR HEPATECTOMY - CASE REPORT AND LITERATURE REVIEW

Case presentation: A 52-year-old male patient, ECOG 0, with nonspecific abdominal pain and unquantified weight loss in February 2018. He underwent full-abdominal MRI showing expansive hepatorenal-centered lesion with 185 x 139 x 140 mm in its three-dimensional axes, involving the retrohepatic vena cava, right adrenal and hepatic lobe, close contact with the hepatic hilum and satellite nodule in segment V/VI measuring 11 mm. Chest tomography with no evidence of disease. Percutaneous biopsy compatible with highgrade sarcoma with muscle differentiation (AE1 / AE3 negative, smooth muscle actin positive, Desmin positive, Protein S-100 negative and CD34 positive). After multidisciplinary discussion, he started chemotherapy with Doxorubicin and Dacarbazine every 21 days ending June 2018 and stable disease in response evaluation. Patient underwent surgery on 8/2/2018 consisting of right hepatectomy and adrenalectomy with monoblock retrohepatic vena cava resection and PTFE prosthesis reconstruction. Pathology revealed poorly differentiated leiomyosarcoma invading hepatic parenchyma with 0.5 cm metastatic hepatic nodule with free hepatic resection and vena cava margins. Patient evolved with a decrease in general condition and hyperbilirubinemia in the sixth POD, with evidence of left hepatic artery thrombosis. The endovascular approach with thrombolytic and stenting allowed its recanalization with reversal of the installed hepatic insufficiency (bilirubin peak of 18 mg / dL). He was discharged at 28th POD with progressive recovery of liver function and is currently undergoing oncologic follow-up. Discussion and Final comments: Postoperative acute arterial thrombosis of major hepatectomies is rare and potentially fatal. Rapid and expert percutaneous management is a safe and effective therapeutic option in view of the morbidity of surgical re-exploration.

 

MissingLinkText

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019