Successful Thrombectomy via a Surgically Reopened Umbilical Vein for Extended Portal Vein Thrombosis Caused by Portal Vein Embolization prior to Extended Liver Resection

The Development of the Umbilical Vein and Its Anatomical and Clinical Significance

The umbilical vein is one of the most essential vessels in the human embryo. Anatomical structures though may vary in several cases. During the fourth and eighth weeks of gestation, the umbilical cord is formed. Initially, two umbilical arteries and veins exist. During development, the obliteration of the right umbilical vein occurs. The fetus and its liver receive macronutrients and oxygen from the placenta via the umbilical vein, which primarily supplies the left lobe of the liver before branching into the left portal vein and the ductus venosus. The ductus venosus directs blood from the umbilical vein directly into the systemic circulation through the inferior vena cava and right atrium, bypassing the fetal liver. In some cases, variations are observed. Disorders of the umbilical veins may involve the persistence of embryological structures, abnormal insertion or course, and the presence of supernumerary vessels. For example, the persistence of the right umbilical vein, duplication of the umbilical vein, and umbilical vein varix are some important variations to acknowledge in order to be able to understand the potential outcomes of the newborn. The majority of venous system anomalies are rare, and some may remain completely asymptomatic. Different forms of umbilical cord abnormalities, however, may be potentially fatal or pose a serious threat to fetal health. Therefore, clinically, early detection of these malformations is highly important in order to make a proper diagnosis and management of care. The aim of this study is to acknowledge the different types of umbilical vein variations through its development and its relation with liver parenchyma in order to achieve a better understanding and planning in surgical interventions. An advanced review search of the literature was undertaken. The literature review was conducted using the search engine of the PubMed database and Google Scholar. The years included in data collection were 1960-2022. All articles that met the inclusion criteria were taken under consideration.

Protein C in a patient with portal vein thrombosis in liver transplantation

Background. The problem of thromboses, including those associated with impaired hemostasis system, is relevant in orthotopic liver transplantation.Aim. To present the experience of intraoperative use of protein C during orthotopic liver transplantation in a patient with a high risk of recurrent portal vein thrombosis.Results. During orthotopic liver transplantation in a patient with a high risk of recurrent portal vein thrombosis, the intraoperative administration of the protein C preparation at a dosage of 500 IU contributed to the increase in plasma level of protein C by 48%. In the post-transplant period, recurrent portal vein thrombosis was not observed. Conclusion. Intraoperative administration of protein C in combination with basic therapy for orthotopic liver transplantation helps to prevent recurrent portal vein thrombosis.