Percutaneous Portal Vein Stent Research Articles

Long-term outcome of primary percutaneous stent angioplasty for pediatric posttransplantation portal vein stenosis.

This study aims to evaluate the long-term efficacy and reintervention rate after primary percutaneous portal vein stent angioplasty for portal vein stenosis (PVS) in pediatric liver transplantation (LT) recipients. From 2004 to 2020, a total of 470 pediatric LTs were performed in our center. All cases were screened for interventional PVS treatment and analyzed retrospectively. We identified 44 patients with 46 percutaneous angioplasties for posttransplantation PVS. The median interval from LT to percutaneous catheter intervention was 5 months (16 days-104 months) with a median follow-up (f/u) period after catheter intervention of 5.7 years (2-156 months). In 40 patients, an endovascular stent was placed as primary (n=38) or secondary (n=2) intervention. The median age at stent placement was 23 (6-179) months with a median weight of 10 kg (6-46 kg). Technical success and relief of PVS were achieved in all patients irrespective of age or weight. Adverse events occurred peri-interventionally in two patients and were resolved with standard care. All primary portal vein (PV) stents remained patent until the end of f/u. Reinterventions have been successfully performed in 10 patients for suspected or proven restenosis, resulting in a primary patency rate of 75% and an assisted patency rate of 25%. The median time to reintervention was 6.2 years (range 1-10 years). The need for reintervention was independent of age or weight at both transplantation and initial angioplasty as well as of additional risk factors due to portal hypertension. Percutaneous transhepatic PV stent angioplasty in children is safe and effective in all age groups, with excellent long-term patency. Primary stent angioplasty should be considered as first-line treatment for PVS after pediatric LT.

Effect of Stent Placement on Survival in Patients with Malignant Portal Vein Stenosis: A Propensity Score–Matched Study

ObjectivePercutaneous portal vein (PV) stent placement can be an effective treatment for symptoms associated with portal hypertension. This study aimed to evaluate the effect of PV stenting on the overall survival (OS) in patients with malignant PV stenosis.Materials and MethodsTwo groups of patients with malignant PV stenosis were compared in this retrospective study involving two institutions. A total of 197 patients who underwent PV stenting between November 2016 and August 2019 were established as the stent group, whereas 29 patients with PV stenosis who were treated conservatively between July 2013 and October 2016 constituted the no-stent group. OS was compared between the two groups before and after propensity score matching (PSM). Risk factors associated with OS were evaluated using the Cox proportional hazards model. Procedure-associated adverse events were also evaluated.ResultsThe stent group finally included 100 patients (median age, 65 [interquartile range, 58–71] years; 64 male). The no-stent group included 22 patients (69 [61–75] years, 13 male). Stent placement was successful in 95% of attempted cases, and the 1- and 2-year stent occlusion–free survival rate was 56% (95% confidence interval, 45%–69%) and 44% (32%–60%), respectively. The median stent occlusion–free survival time was 176 (interquartile range, 70–440) days. OS was significantly longer in the stent group than in the no-stent group (median 294 vs. 87 days, p < 0.001 before PSM, p = 0.011 after PSM). The 1- and 3-year OS rates before PSM were 40% and 11%, respectively, in the stent group. The 1-year OS rate after PSM was 32% and 5% in the stent and no-stent groups, respectively. Anemia requiring transfusion (n = 2) and acute thrombosis necessitating re-stenting (n = 1) occurred in three patients in the stent group within 1 week.ConclusionPercutaneous placement of a PV stent may be effective in improving OS in patients with malignant PV stenosis.

Outcomes and complications for portal vein or superior mesenteric vein injury: No improvement in the era of damage control resuscitation

IntroductionPortal vein (PV) and superior mesenteric vein (SMV) injuries are lethal. We hypothesised outcomes have improved with modern trauma care. MethodsWe reviewed patients presenting to our Level 1 trauma centre over ten-years with PV/SMV injuries, analysing physiology, operative management, associated injuries, and outcomes. ResultsTwenty-four patients had 7 PV and 15 SMV injuries, 2 had both; all had operative exploration. Sixty-seven percent had penetrating trauma. While many had normal vitals, profound acidosis was common. All patients had ≥2 additional abdominal injuries, liver most common (50%). Additional abdominal vascular injuries were more common in non-survivors than survivors: IVC 46% vs 22%, common hepatic artery 20% vs 0%, SMA 26% vs 11%. The mean injury severity score (ISS) was 32.4, and the mean new injury severity score (NISS) was 44.5. Mortality was 63%. Eleven patients died from exsanguination, two from SMV thrombosis, and two from sequelae of other injuries. All survivors had venorrhaphy, as did 8 non-survivors. Non-survivors were also shunted; had ligation; or bypass, shunting, and ligation. Three exsanguinated prior to repair. Two survivors had SMV related complications. One with proximal SMV injury developed severe venous congestion and multiple enterocutaneous fistulae. Another developed an arterioportal fistula, managed with embolisation and percutaneous portal vein stenting. ConclusionDespite advances (REBOA, damage control surgery and resuscitation, liberal use of ED thoracotomy), PV and SMV injuries remain lethal. Injuries to other structures are ubiquitous. Early exsanguination is the major cause of death. All survivors had successful venorrhaphy; those who required more complex repairs died. Compromised mesenteric venous flow causes morbidity and mortality.

Abstract No. 532 Percutaneous portal vein stent placement: efficacy and predictors of patency: a single-center experience in 27 patients

To evaluate patency of portal vein (PV) stents and identify factors and predictors of stent patency. From May 2007 to March 2017, 27 patients (17 males, 10 females, mean age of 60.3, range 37-83) with main PV stenosis successfully treated with percutaneous stent were reviewed. Etiologies included: cholangiocarcinoma (n = 16), OLT stricture (n = 4), HCC (n = 3), gastric cancer (n = 2), colon cancer (n = 1) and surgical injury (n = 1). Overall survival (OS), primary patency (PP, assessed with abdominal Doppler, CT or MRI) and lab values were recorded. Mean OS was 538.5 days compared to mean PP of 533.3 days (range, for both 18-3758). Splanchnic vein involvement (p = 0.003), Child-Pugh score (p = 0.047), PV occlusions (p = 0.018), age at procedure (p = 0.038), and primary tumor staging (p = 0.045) were all found to be correlates associated with decreased PV stent patency. Specifically, patients with a primary tumor staging greater than 2 experienced decreased PV stent patency (p = 0.0183). Patients with an albumin level greater than 3 g/dL (p = 0.0017), or an alkaline phosphatase level within the normal range of 44-147 U/L (p = 0.0008) at the time of procedure experienced statistically significant longer patency. PV stent placement is safe with moderate primary patency. Factors associated with decreased patency include splanchnic vein involvement, high Child-Pugh score, PV complete occlusion, and primary tumor component (T) of TNM cancer staging. Albumin and alkaline phosphatase levels at time of procedure are predictive for portal vein stent patency.

Endoscopic ultrasonography-guided placement of a transhepatic portal vein stent in a live porcine model.

Background and Objectives:Percutaneous portal vein (PV) stent placement is used to manage PV occlusion or stenosis caused by malignancy. The use of endoscopic ultrasonography (EUS) has expanded to include vascular interventions. The aim of this study was to examine the technical feasibility and safety of EUS-guided transhepatic PV stent placement in a live porcine model.Materials and Methods:EUS-guided transhepatic PV stent placement was performed in six male miniature pigs under general anesthesia using forward-viewing echoendoscope. Under EUS guidance, the left intrahepatic PV was punctured with a 19-gauge fine-needle aspiration (FNA) needle and a 0.025 inch guidewire inserted through the needle and into the main PV. The FNA needle was then withdrawn and a needle-knife inserted to dilate the tract. Under EUS and fluoroscopic guidance, a noncovered metal stent was inserted over the guidewire and released into the main PV.Results:A PV stent was placed successfully in all six pigs with no technical problems or complications. The patency of the stent in the main PV was confirmed using color Doppler EUS and transhepatic portal venography. Necropsy of the first three animals revealed no evidence of bleeding and damage to intra-abdominal organs or vessels. No complications occurred in the remaining three animals during the 8 weeks observation period.Conclusions:EUS-guided transhepatic PV stent placement can be both technically feasible and safe in a live animal model.

Portal vein occlusion following pancreaticoduodenectomy and portal vein resection: treatment by percutaneous portal vein stent

Portal vein occlusion following pancreaticoduodenectomy and portal vein resection: treatment by percutaneous portal vein stent

Portal vein occlusion following pancreatico-duodenectomy and portal vein resection: treatment by percutaneous portal vein stent

Portal vein occlusion following pancreatico-duodenectomy and portal vein resection: treatment by percutaneous portal vein stent

Biliary and portal vein strictures following treatment of Hodgkin’s lymphoma

Treatment of abdominal lymphoma can be associated with bowel stricture or perforation. Rarely, the common bile duct or portal vein can be involved. This is the first case of stricture formation of both the portal vein and common bile duct in a patient following successful treatment of lymphoma. The development of extensive hilar varices rendered surgical management high risk. A staged approach to treatment was used. First, a percutaneous portal vein stent was placed, resulting in resolution of the hilar varices. This was followed by a surgical hepaticojejunostomy, performed without complication. Gastrointestinal complications are rare following treatment of lymphoma but may affect a variety of sites. The safe and effective treatment of this case highlights the benefit of a multidisciplinary approach to complex medical and surgical problems.

Phrenic Artery Hemorrhage after Percutaneous Portal Vein Stenting to Treat Cavernous Transformation Following Living Donor Liver Transplantation: A Case Report

Cavernous transformation is a condition which has an acutely developing harmful effect over intestinal circulation compromising the patients' life before development of portal hypertension and its results. We present the case of phrenic artery hemorrhage after successful percutaneous portal vein stenting to treat cavernous transformation following LDLT. The patient survived the hazard complication with prompt surgery. Three factors may be related to the rare complication in the case were analyzed, including affluent new vessels around the diaphragm related to LDLT procedure, high puncture site allowing the diaphragm been injured, and anticoagulation given before the puncture and soon after the procedure. Cautions should be taken for the interventional procedures in this extreme condition. Cavernous transformation is a condition which has an acutely developing harmful effect over intestinal circulation compromising the patients' life before development of portal hypertension and its results (see the work of Harmanci and Bayraktar (2007)). It is even worse when this happens in a patient after LDLT (living donor liver transplantation). Herein we have presented a case of phrenic artery hemorrhage after successful percutaneous portal vein stenting to treat cavernous transformation following LDLT. The patient survived the hazard complication with prompt surgery.