Sarah Bos

72 CHAPTER 5 Thrombotic Complications Besides an acquired hypercoagulable state related to hepatobiliary surgery, multiple additional risk factors for post- operative thrombotic events may be present in these patients, including (preoperative) cancer, local vascular abnormalities, local abnormalities in blood flow, presence of indwelling catheters, and prolonged postoperative immobilization.(64,65) Partial Hepatectomy Venous thromboembolism (VTE) occurs after partial hepatectomy, with a reported incidence varying from 2.9 to 4.8%.6.(64–66) In one of the larger retrospective studies, VTE was found to be directly proportional to the magnitude of hepatectomy.(64) Major hepatectomy was associated with a threefold increase in the risk of VTE (1 VTE per 17 patients) compared with minor hepatectomy (1 VTE per 48 patients).(64) Besides deep vein thrombosis and pulmonary embolism, portal vein thrombosis (PVT, Fig. 1) is a frequent complication after hepatectomy, with a reported incidence varying from 2.1 to 9.1%.(67,68) As portal venous flow is an important determinant of liver regeneration,(69–71) it is possible that reduced portal venous flow due to PVT results in delayed liver regeneration.