Journal article
Percutaneous portal vein recanalization using self-expandable nitinol stents in patients with non-cirrhotic non-tumoral portal vein occlusion.
- Marot A Department of Gastroenterology and Hepatology, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
- Barbosa JV Division of Gastroenterology and Hepatology, centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
- Duran R Department of Radiodiagnostic and interventional radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
- Deltenre P Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Department of Gastroenterology and Hepatology, Clinique St Luc, Bouge, Belgium. Electronic address: pierre.deltenre01@gmail.com.
- Denys A Department of Radiodiagnostic and interventional radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
- 2018-12-04
Published in:
- Diagnostic and interventional imaging. - 2019
Portal hypertension
Portal vein occlusion
Portal vein recanalization
Adult
Alloys
Feasibility Studies
Female
Follow-Up Studies
Humans
Hypertension, Portal
Liver Function Tests
Male
Middle Aged
Phlebography
Portal Vein
Stents
Venous Thrombosis
Young Adult
English
PURPOSE
The purpose of this study was to evaluate the feasibility, safety, and efficacy of portal vein recanalization (PVR) and propose a new classification for better selecting candidates with portal vein occlusion (PVO) in whom PVR could be feasible.
MATERIALS AND METHODS
The charts of 15 non-cirrhotic patients in whom stent placement using a trans-hepatic approach was attempted for the treatment of PVO with cavernous transformation were reviewed.
There were 12 men and 3 women with a mean age of 47 ± 12 years (range: 22–60 years) [corrected].
Intrahepatic involvement was classified into 3 groups according to the intrahepatic extent of PVO: type 1 included occlusions limited to the origin of the main portal vein and/or the right or left portal branches, type 2 included type 1 plus extension to the origin of segmental branches, type 3 included type 2 plus extension to distal branches.
RESULTS
There were 6 patients with PVO type 1, 7 patients with PVO type 2, and 2 patients with PVO type 3. Indications for PVR were gastrointestinal bleeding (n=6), portal biliopathy (n=2), reduce portal pressure before surgery (n=4), or other (n=3). PVR was successful in 13 patients (87%) with no severe side effects. Failure of PVR or early stent thrombosis occurred in 100% of type 3 vs. 8% of type 1 and 2 patients (P=0.03). During a mean follow-up of 42±28 months (range: 6-112 months), patients with a permeable stent had resolution of portal hypertension-related manifestations. In 13 patients in whom PVR was feasible, stent permeability was 77% at 2 years (87% vs. 60% in patients who received anticoagulation or not, respectively; P=0.3).
CONCLUSION
PVR is feasible in most patients with non-cirrhotic, non-tumoral portal vein occlusion when there is no extension of the occlusion to distal branches.
The purpose of this study was to evaluate the feasibility, safety, and efficacy of portal vein recanalization (PVR) and propose a new classification for better selecting candidates with portal vein occlusion (PVO) in whom PVR could be feasible.
MATERIALS AND METHODS
The charts of 15 non-cirrhotic patients in whom stent placement using a trans-hepatic approach was attempted for the treatment of PVO with cavernous transformation were reviewed.
There were 12 men and 3 women with a mean age of 47 ± 12 years (range: 22–60 years) [corrected].
Intrahepatic involvement was classified into 3 groups according to the intrahepatic extent of PVO: type 1 included occlusions limited to the origin of the main portal vein and/or the right or left portal branches, type 2 included type 1 plus extension to the origin of segmental branches, type 3 included type 2 plus extension to distal branches.
RESULTS
There were 6 patients with PVO type 1, 7 patients with PVO type 2, and 2 patients with PVO type 3. Indications for PVR were gastrointestinal bleeding (n=6), portal biliopathy (n=2), reduce portal pressure before surgery (n=4), or other (n=3). PVR was successful in 13 patients (87%) with no severe side effects. Failure of PVR or early stent thrombosis occurred in 100% of type 3 vs. 8% of type 1 and 2 patients (P=0.03). During a mean follow-up of 42±28 months (range: 6-112 months), patients with a permeable stent had resolution of portal hypertension-related manifestations. In 13 patients in whom PVR was feasible, stent permeability was 77% at 2 years (87% vs. 60% in patients who received anticoagulation or not, respectively; P=0.3).
CONCLUSION
PVR is feasible in most patients with non-cirrhotic, non-tumoral portal vein occlusion when there is no extension of the occlusion to distal branches.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.diii.2018.07.009
- PMID 30503174
- Persistent URL
- https://folia.unifr.ch/global/documents/125416
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