Clinical Value of Ultrasound in Evaluating Stent Placement for Managing Graft Stenosis after Meso-rex Bypass

Abstract

Objective To explore the feasibility of using ultrasound to evaluate stent placement for managing graft stenosis after Meso-rex bypass for cavernous transformation of the portal vein in adults. Methods This study enrolled the patients who underwent Meso-rex bypass due to cavernous transformation of the portal vein,were diagnosed graft stenosis by postoperative ultrasound,and then underwent percutaneous portal vein puncture portography and stent placement.We then compared the ultrasonic measurement indicators and sonographic manifestations before and after stent placement,and evaluated the alleviation of portal hypertension symptoms after stent placement and related clinical indexes. Results Finally,8 patients were enrolled in this study,including 5 males and 3 females,with an average age of(32.4±14.7)years.The median duration of follow-up was 26 months after stent placement.The mean diameter of graft stenosis was(2.74±0.23)mm after Meso-rex bypass and became wider[(7.23±0.68)mm]after stent placement(P=0.000).The mean maximum velocity at graft stenosis was(195.88±30.83)cm/s after Meso-rex bypass and became lower[(72.75±29.94)cm/s]after stent placement(P=0.000).The color Doppler flow imaging at graft stenosis presented colorful blood flow,and presented regular near laminar flow within the stent and characteristic reverse flow within the left portal vein after stent placement.No gastrointestinal bleeding or ascites occurred after interventional therapy,and the mean thickness of spleen decreased from 6.0 cm before stent placement to 5.4 cm(P=0.018).After stent placement,the platelet count increased from(51.57±18.83)×109/L to(149.00±58.96)×109/L(P=0.002),and the serum ammonia level decreased from(66.25±21.78)μmol/L to(44.88±10.60)μmol/L(P=0.012). Conclusions Ultrasound can accurately assess graft patency before and after stent placement in patients with stenosis after Meso-rex bypass,and effectively monitor the hemodynamic changes in the portal venous system.The clinical symptoms can be relieved after interventional therapy.