Real-Time Ultrasound-Guided Thrombectomy for Extensive Portal Vein Thrombosis in Living Donor Liver Transplantation

Thrombectomy is a routine or common practice for treating organized portal vein thrombosis (PVT) during liver transplantation. However, this procedure is often performed in a blinded fashion and can result in insufficient thrombectomy or devastating consequences such as injury to the retropancreatic portal vein where prompt repair is very difficult. To overcome these drawbacks for blind thrombectomy, we herein describe a new technique that makes complex thrombectomy safe and easy under direct ultrasound vision. This procedure is readily available and highly reproducible and can be used as the standard procedure for treating extensive PVT. •A new technique that makes complex thrombectomy safe and easy under direct ultrasound vision is proposed.•Thanks to a real-time vision of the tip of the tonsil clamp, the residual thrombus, and the inner walls of the deep portal vein, the residual thrombus can be safely and completely peeled off from the wall of the portal vein.•This procedure is readily available and highly reproducible and can be used as the standard procedure for treating extensive portal vein thrombosis.