Abstract
Purpose: Spectrum of PV patency and integrity percutaneous restoration techniques is presented. Material and methods: Total twenty patients with portal hypertension due to PV patency & integrity problem; among them percutaneous recanalization was attempted in fifteen patients with PV tumor thrombus using a novel endoluminal bipolar radiofrequency device. The procedure was completed in twelve of fifteen RFA cases; RFA was followed by balloon angioplasty (six cases) or vascular stent placement (six cases). In two cases catheter directed local thrombolysis was performed to acutely manifest fresh PV thrombosis, caused by thrombophylia and HCC. In two cases of pancreatitis induced PV thrombosis & stricture and one case of pancreatitis induced PV thrombosis & stricture and porto-biliary fistula, PV stenting was performed. The PV tributary was percutaneously accessed under US guidance and 5G guide catheter was manipulated through the obstruction using guidewire technique under DSA guidance. In case of thrombolysis thrombolytic agent was injected directly distal to the thrombus, the stenting procedure was completed by self-expanding vascular stent placement. Results: The technical success rate was 85.0%; in three cases (15.0%) wire conduction through the organized thrombus was impossible. Posprocedure portography documented significantly improved portal vein blood flow in all patients, to whom the procedure was completed. Porto-biliary fistula was successfully managed by percutaneous stenting. In three cases postprocedure bleeding was documented, which led to multiorgan failure and death in one case. Conclusions: The management of PV patency and integrity problems by percutaneous stenting or endoluminal RFA and stenting is an effective technique; it should be suggested as a treatment option for otherwise incurable patients and might be used as a bridge for further treatment. Post-procedure intraperitoneal bleeding is a possible life-threatening complication which should be prevented by procedure track ablation or embolization.
Highlights
Portal vein thrombosis is being increasingly recognized in cirrhotic and malignant conditions like hepatocellular carcinoma, but in non-cirrhotic patients . [1]
We report clinical application of percutaneous imaging guided management, including use of endoluminal radiofrequency ablation (RFA) device for mainly oncology, and non-oncology cohort of twenty patients with portal vein (PV) patency and integrity problems
In fourteen patients with PV tumor thrombus and one case of cirrhosis percutaneous recanalization using a novel endovascular bipolar radiofrequency device was attempted; the procedure was completed in twelve cases; In all completed oncology and cirrhosis cases RFA was followed by balloon angioplasty or vascular stent placement
Summary
Portal vein thrombosis is being increasingly recognized in cirrhotic and malignant conditions like hepatocellular carcinoma, but in non-cirrhotic patients . [1]. Percutaneous transhepatic placement of portal vein stent as a possible treatment option for PV hypertension symptoms relief in patients with recurrent perihilar biliary malignancy has been reported (6). It should be mentioned, that a direct access to PV might be performed using transjugular and transsplecnis routes (7,8,9), it should be mentioned, that transsplenic access is associated with relatively high risk of intrasplenic or intraperitoneal bleeding. SMV, SV and PV thrombosis is not common, but not very rare problem in non-oncology patients Such pathologies, as thrombophilic conditions, pancreatitis major abdominal surgery and repetitive abdominal trauma may cause SMV and PV thrombosis requiring percutaneous thrombectomy and thrombolysis and vascular stent placement (11,12,13)
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