Treatment Of Portal Vein Stenosis Research Articles

Balloon angioplasty versus stent placement for the treatment of portal vein stenosis in children: a single center experience.

To evaluate the safety and efficacy of percutaneous interventional treatment of portal vein stenosis in children. A retrospective analysis of all interventional treatments for portal vein stenosis in pediatric patients at a single institution from 2010 to 2021 was conducted. Platelet count, spleen size and portal vein flow velocity were assessed during the follow-up period. Primary and primary assisted patency time were determined. A total of ten children (median age 28.5months, interquartile range (IQR): 2.75-52.5months) with portal vein stenosis after Mesorex-Shunt (n = 4), liver transplantation (n = 3) and other etiologies (n = 3) underwent 15 interventional procedures. There were five reinterventions and one discontinued intervention. The technical success rate was 93.3% (14/15) and clinical success of treated patients was 100% (14/14). Median follow-up was 18months (IQR: 13.5-81months). The median primary patency time for stent placement was 70months (IQR: 13.5-127.25months). For balloon angioplasty, the median primary patency time was 9months (IQR 7.25-11.5months), while the median assisted primary patency time was 14months (IQR: 12 to 15months). Platelet count, spleen size and portal vein flow velocity reliably corresponded to recurrence of portal vein stenosis in asymptomatic patients during follow-up. Interventional treatment is a safe and efficient method to treat portal vein stenosis with long patency times, regardless of etiology. Primary stent placement shows a higher primary patency time than balloon angioplasty. Implementation of stent placement as the primary interventional method may improve patency times and reduce the need for repeat reinterventions in pediatric patients.

Abstract No. 219 Portal Vein Angioplasty/Stenting in the Treatment of Portal Vein Stenosis

Abstract No. 219 Portal Vein Angioplasty/Stenting in the Treatment of Portal Vein Stenosis

Is stenting really necessary during primary angioplasty for portal vein stenosis after pediatric liver transplantation?

To the editor, The paper by Bukova et al.1 that was published on liver transplantation dangerously questions the possibility of effectively treating portal vein stenosis after pediatric liver transplantation without the need for primary stenting. In a retrospective cohort of a total of 470 pediatric liver transplants performed in a single center from 2004 to 2020, they reported very positive outcomes with a mean follow-up of 5.7 years and they concluded that primary stent angioplasty should be considered as first-line treatment for portal vein stenosis after pediatric LT. In our opinion, this data must be considered with caution in pediatric patients who have a much longer life expectancy after liver transplantation. The placement of metal stents in pediatric patients hinders the possibility of future re-transplantation due to the technical challenges of performing new vascular anastomoses on vessels engaged with unremovable metal devices. We believe that Liver Transplantation readers should be aware that there is quite sufficient evidence to claim that simple angioplasty is advisable rather than primary stent angioplasty to treat pediatric posttransplantation portal vein stenosis. Excellent mid-term and long-term outcomes are reported by several studies.2–5 More data will be made available by the international PORTAL registry sponsored by the University of Groningen, involving more than 30 liver transplant centers all over the world. Registry completion and results publication are expected in a few months.

Endovascular treatment of recurrent gastrointestinal bleedings in patients with portal vein stenosis after pancreatoduodenal resection

The OBJECTIVE was to show a potential and efficiency of endovascular methods in treatment of patient with portal vein stenosis after pancreatoduodenal resection complicated by the development of varices in the portomesenteric basin and recurrent gastrointestinal bleeding. METHODS AND MATERIALS. We presented the results of treatment of two patients who previously underwent pancreatoduodenal resection for pancreatic head cancer. 2 patients were admitted to the Clinic of the Research Institute of Surgery and Emergency Medicine of Pavlov University with a clinical picture of recurrent gastrointestinal bleeding. RESULTS. Both patients had no visible bleeding site with endoscopy, but had recurrent melena and hemoglobin loss. On radiological imaging we found a portal vein stenosis with a significant varicose transformation of the mesenteric basin. Endovascular stent placement for portal vein stenosis was performed in both cases with no recurrence of bleedings and no complications. CONCLUSION. Portal vein stenosis after pancreatoduodenal resection is a rare complication, which can manifest in recurrent gastrointestinal bleeding with no visible bleeding site on endoscopy. Endovascular methods are feasible and safe in treatment of portal vein stenosis with no relapse. Multidisciplinary approach in diagnostic and treatment of such patients allow to identify and remove the cause of recurrent bleeding.

Safety and Efficacy of Endovascular Treatment of Portal Vein Stenosis in Liver Transplant Recipients: A Systematic Review.

To evaluate the efficacy of Angioplasty and Stent Placement for the treatment of Portal Vein Stenosis in Liver Transplant Recipients by performing a systematic review. The PubMed Database was extensively searched for articles describing Portal Vein Stenosis (PVS) as a complication in Liver Transplant (LT) patients. The initial database search yielded 488 unique records published in the PubMed Database, 19 of which were deemed to meet the inclusion criteria. Outcomes were separated into 2 groups (Group A included patients with primary angioplasty, Group B included patients with primary stent placement), and further subdivided into Adult and Pediatric populations. Group A included a total of 282 LT patients with portal vein stenosis. The population was predominantly pediatric (n = 243). Group B included a total of 111 LT patients with portal vein stenosis. This population was predominantly adult (n = 66). Technical success was significantly higher in both Group B pediatric (100%) and adults (97%) compared to Group A (69.5%) and (66.7%) respectively. Re-stenosis rates were significantly lower in Group B pediatric group compared to Group A (2.3% vs 29.7%, χ2 = 13.9; p < 0.001). Overall major (3.1%) and minor complications rates (1.5%) were low. Primary stent placement appears to have higher technical success in both populations and lower re-stenosis rates for treatment of PVS in pediatric populations.

Abstract No. 661 Safety and efficacy of endovascular treatment of portal vein stenosis in liver transplant recipients: a systematic review

Abstract No. 661 Safety and efficacy of endovascular treatment of portal vein stenosis in liver transplant recipients: a systematic review

Stent Placement for the Treatment of Portal Vein Stenosis or Occlusion in Pediatric Liver Transplant Recipients

To evaluate the efficacy of stent placement for the treatment of portal vein (PV) stenosis or occlusion in pediatric liver transplant recipients. Written informed consent was obtained from a legal guardian, and our institutional review board approved this study. Percutaneous (n = 10) or intraoperative (n = 2) stent placement was attempted in 12 pediatric recipients (age range, 6-102 months) via the percutaneous transhepatic or inferior mesenteric vein route. Stents 6-10 mm in diameter were placed. Technical and clinical success, complications, and patency of the PV were retrospectively analyzed. Technical success was achieved in 10 of 12 patients (83%) and clinical success was achieved in eight patients (67%). Eight of the 10 patients in whom technical success was achieved (80%) remained healthy with a patent PV during the 10-58-month clinical follow-up period. One patient with technical success died of acute rejection without recurrent PV complications and another died of acute rejection after stent replacement as a result of an hourglass deformity of a deployed stent with partial thrombosis. No major procedural complications occurred. Based on this study in a relatively small number of patients, PV stent placement seems to be a safe and effective method for the treatment of posttransplantation PV stenosis or occlusion in pediatric patients.

Effect of a portal venous stent for gastrointestinal hemorrhage from jejunal varices caused by portal hypertension after pancreatoduodenectomy

We report herein the case of a 64-year-old man successfully treated by portal venous stent placement for repeated gastrointestinal bleeding associated with jejunal varices. He was admitted to our hospital with melena 8 years after having a pancreatoduodenectomy for carcinoma of the papilla of Vater. From portogram findings showing severe portal vein (PV) stenosis and dilated collaterals through the jejunal vein of the Roux-en-Y loop, jejunal varices resulting from PV stenosis were suspected as the cause of the melena. A metallic stent was placed in the PV following percutaneous transhepatic PV angioplasty. Although the cure of hemorrhagic jejunal varices caused by PV stenosis is difficult in patients who have undergone major abdominal surgery, patency of the stent in this patient has been maintained for 32 months without gastrointestinal hemorrhage. Metallic stent placement is recommended as a useful treatment for PV stenosis that is less invasive than open surgery.

Angioplasty treatment of portal vein stenosis in children with segmental liver transplants: mid-term results.

Percutaneous venoplasty has showed excellent technical success and excellent early results in treating portal vein stenoses in children with reduced-size liver transplants. We review the mid-term results in 22 children in whom portal venoplasty was attempted. During 27 months, percutaneous transhepatic portal venoplasty was attempted in 22 children with portal vein stenoses. Patients presented with symptoms of portal vein hypertension or were identified by routine surveillance with posttransplantation Doppler sonography. All stenoses were verified with angiography. Venoplasty was performed by direct puncture of an intrahepatic portal vein before balloon angioplasty of the stenotic segment. Patients were followed up with sonographic surveillance, and reintervention was performed as needed. In patients who had suboptimal results after portal venoplasty or who developed recurrent stenoses, intravascular stents were placed across stenoses. In 16 of 22 patients, initial clinical and technical success was achieved. In the six patients who underwent unsuccessful procedures, complete occlusion of the portal vein precluded access to the extrahepatic portal vein. Of the 16 patients who underwent successful procedures, intravascular stents were placed at the time of initial venoplasty in five patients for elastic stenosis. In seven other patients, portal vein restenosis occurred after venoplasty (mean, 6.3 months), necessitating intravascular stent placement. Four patients who underwent successful venoplasty without stent placement have required no further intervention. Portal vein patency has been maintained in all 16 patients who underwent technically successful procedures for 4-29 months (mean, 20 months). In children with reduced-size liver transplants who experience delayed portal vein stenosis, percutaneous transhepatic portal venoplasty has achieved encouraging mid-term results. It is the procedure of choice in our hospital and often eliminates the need for surgical revision, portacaval shunting, or retransplantation.