الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Portal vein thrombosis (PVT) is a common complication of ESLD with an incidence of 0.6–16% in patients with well-compensated disease, increasing up to 35% in cirrhotic patients with hepatocellular carcinoma.
The preoperative identification of PVT aim to exclude patients with malignant thrombosis from liver transplantation waiting list. Several classifications have been proposed so far; the Yerdel classification gained the greatest acceptance worldwide.
Nevertheless, PVT is still a serious risk factor. During surgery, the initial attempt to overcome PVT is thrombectomy. It has been reported to be successful in 31–95 %.
The surgical strategies are: resection of the affected segment and primary anastomosis, thrombectomy, grafting to superior mesenteric vein, to the splenic vein or varix, and portal arterialization, hemitransposition cavoportal, renoportal anastomosis and multivisceral transplant.
Eversion thrombectomy or the recently developed modified eversion thrombectomy is the standard technique for removal of PV thrombus at time of transplant, and if the thrombus is adherent to the wall of the vein thromboendovenctomy may be used.
In the presence of complete thrombosis of the venous mesentericoportal system (grade IV) and in the absence of other tributaries for revascularization, hemi-transposition cavoportal, renoportal anastomosis, portal arterialization and multivisceral transplantation are alternatives.
Choosing the optimal approach in an individual case depends on the preoperative diagnosis and the surgeon’s preference.
In this study we compared eversion thrombectomy technique with the modified one and we found that the new technique was superior to the old one in many aspects: Minimal blood loss was achieved during the thrombectomy procedure, Lower recurrence rate, Lower operative time, and Lower mortality rate.