04:03 PM Abstract No. 80 Technical success, efficacy, and safety of portomesenteric venous intervention following non-transplant hepatobiliary or pancreatic surgery

Abstract

To assess the technical success, efficacy and safety of portomesenteric venous (PMV) intervention for PMV stenosis or occlusion following hepatobiliary or pancreatic (HPB) surgery. A retrospective review identified 42 patients with PMV occlusion (21%) or stenosis (79%) who underwent attempted PMV balloon venoplasty and/or stenting following HPB surgery between 6/2011 and 4/2018. Mean patient age was 60.1 years and 21 (50%) patients were female. Indications for intervention included mesenteric (43%) or portal venous (28%) hypertension or to maintain patency (24%). 70% received post-intervention anticoagulation. Main outcome parameters were technical success, primary patency rates and complications. Technical success was compared by venous pathology and primary patency by anticoagulation status using Fischer’s exact test. Rates of primary patency by stent group were estimated using Kaplan-Meier method. Technical success was 91% and significantly higher in patients with stenosis (100%) versus occlusion (56%) (p=0.001). Interventions included balloon venoplasty (2.6%), venoplasty/stenting (94.8%) and endovascular mechanical thrombectomy plus venoplasty/stenting (2.6%), with uncovered, covered and both stent types placed in 65%, 16% and 19%, respectively. Immediate venous collateral decompression was seen in 77% of patients as well as eventual resolution of ascites (64%), gastrointestinal bleeding (100%) and intestinal angina (93%). At an average imaging follow-up of 8.6±8.8 months, primary stent patency was 76% with 9 patients developing in-stent stenosis (n=3), non-occlusive thrombus (n=3) or occlusive thrombus (n=3), 5 of whom underwent re-stenting. 6- and 12-month primary patency rates for uncovered, covered and both stent groups were 72% and 50%, 100% and 100% and 83% and 83%, respectively. There was no significant difference in primary stent patency by anticoagulation status (p=1.0). There were two peri-procedural complications (4.8%). Portomesenteric venoplasty/stenting following HPB surgery is safe with a high rate of technical success if patients are intervened upon before chronic occlusion. 12-month primary stent patency may be better with covered stents.