Antegrade transmesenteric stenting of a kinked portal vein after acute liver transplant

A 54 year-old male with alcoholic cirrhosis and a previous liver transplant underwent second transplantation. Very low Doppler velocities were identified within the portal vein after surgery. At surgical re-exploration 3 days later, a kinked portal vein was identified; this improved after manually lifting and repositioning the liver. A surgical bypass was considered however his superior mesenteric vein was judged too small for a durable anastomosis. Diffuse oozing from acute portal hypertension was observed requiring multiple units of blood; this led to a severe coagulopathy. The patient returned to surgery a third time, the next day, and Interventional Radiology was consulted for emergent portal vein stent placement.