Portal vein anastomotic stenosis after liver transplantation is an uncommon but clinically important complication that can lead to portal hypertension, ascites, and impaired graft inflow.We present a case of a liver transplant recipient with persistent ascites in whom Doppler ultrasound and CT angiography suggested a focal narrowing of a complex anastomosis between portal vein and mesenteric varicose veins.An attempted TIPS procedure was unsuccessful because the stenotic segment could not be safely traversed; however, venography provided additional clues supporting a hemodynamically relevant obstruction.On the following day, a percutaneous transhepatic approach enabled definitive visualization of a short, high-grade stenosis, which was successfully treated with balloon-assisted stent placement.Early Doppler ultrasound demonstrated restored hepatopetal portal flow.This case highlights the value of a staged percutaneous stent placement technique when TIPS is technically unfeasible.
Vogl et al. (Wed,) studied this question.