Abstract No. 597 Successful use of drug-eluting balloons for the management of a recalcitrant hepatic vein stenosis following extended right hepatectomy in a child with hepatoblastoma

Abstract

Angioplasty with drug-eluting balloons is a treatment option in peripheral arterial occlusive disease and coronary artery stenosis. It has shown benefits in terms of patency, re-stenosis and distal flow of the treated vessel. It also shows promising results in the treatment of dysfunctional AV fistulas. Mechanical and biological response due to local injury during angioplasty leads to restenosis. The antineoplastic drug delivered in the vessel wall inhibits the cell proliferation improving the long-term results. We present a case in which drug-eluting balloons were used to treat a recalcitrant hepatic vein stenosis following venous surgical reconstruction after hepatoblastoma resection. 3-year, 6-month-old boy, history of hepatoblastoma at 15 months. Treated with chemotherapy + right hepatectomy + hepatic vein/inferior vena cava reconstruction. Presented with acute stenosis due to thrombosis. Treated 5 times with conventional angioplasty with recurrence of the stenosis. Stent appeared not an optimal option. It was decided to use a Paclitaxel coated balloon to alleviate symptoms and provide a long-term therapeutic alternative. Informed consent was obtained. A 6mm-4cm Paclitaxel drug coated balloon was utilized. Control venography was performed at 8 and 24 weeks after the initial intervention. Treatment was repeated at controls. Results were compared to standard angioplasty done before. The patient showed a significant clinical improvement, without any signs or symptoms of hepatic vein hypertension. The 8 and 24 weeks follow-up venography showed superior patency of the hepatic vein and post-surgical area in comparison with the previous standard angioplasty procedures. No complications were observed. 32 weeks clinical follow-up is satisfactory. No new interventions are planned. In the case presented, drug-eluting balloons showed superior 8 and 24 weeks patency and clinical outcome in a child with post-surgical hepatic vein stenosis in comparison to conventional balloons. Its use in similar cases of hepatic vein stenosis due to other etiologies may be considered in the future.