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

Funaki, Brian; Rosenblum, Jordan D.; Leef, Jeffrey A.; Hackworth, C A; Szymski, George X.; Alonso, Estella M.

doi:10.2214/ajr.169.2.9242775

Cited by 66 publications

(52 citation statements)

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“…6,7 A smaller recipient-to-donor body weight ratio and the use of a reduced graft size are risk factors in pediatric patients and manifest acutely with liver failure. Delayed presentation is due to intimal hyperplasia or perianastomotic fibrosis, with patients then presenting with RA, pleural effusion, and alteration of liver function tests.…”

Section: Hepatic Vein Stenosismentioning

confidence: 99%

“…After diagnosis, usually by Doppler imaging, selective catheterization of the hepatic vein is performed to confirm the stenosis and pressure gradient greater than 3 mm Hg. 6,8 A transjugular transfemoral approach with balloon dilation is the preferred treatment. A transhepatic approach and the use of a metallic stent are reserved for unresponsive patients.…”

Section: Hepatic Vein Stenosismentioning

confidence: 99%

“…Portal vein stenosis is a rare cause (1%-2%) 7 of RA and usually presents with symptoms of portal hypertension, such as ascites or hemorrhage. Confirmation of stenosis and pressure gradient is usually via transhepatic portography.…”

Section: Portal Vein Stenosismentioning

confidence: 99%

“…The procedure is associated with a good success rate, with complications, if any, due to the transhepatic approach, for which embolization can be performed with agents such as coils or Gelfoam. 7,12,13 Inferior vena cava stenosis Inferior vena cava stenosis is rare (1%) 12 and usually caused by stenosis at the site of anastomosis or just superior to it and can be iatrogenic or related to the scar. Clinical manifestations are ascites, renal failure, lower limb swelling, or altered liver function tests.…”

Section: Portal Vein Stenosismentioning

confidence: 99%

“…1,28 Splenic artery embolization A lesser known yet minimally invasive treatment option is proximal splenic nerve embolization. 8 Splenic nerve embolization has been effective as a minimally invasive therapeutic option in a variety of conditions, including hematologic disorders and splenic trauma, replacing surgery that has been associated with morbidity and mortality. 29 Recently, the role of splenic nerve embolization in hyper-splenism associated with portal hypertension has increased.…”

Section: Transjugular Intrahepatic Portosystemic Shuntmentioning

confidence: 99%

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Untitled

2015

Exp Clin Transplant

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Objectives: Recipients of liver transplant are surviving longer as both the surgical procedure and postsurgical care have improved. Despite improvements, serious complications from the procedure remain that significantly affect patient outcome and may result in retransplant. Refractory ascites is one complication, occurring in about 5.6% of transplant recipients. Management of refractory ascites after liver transplant presents a challenge to the multidisciplinary team caring for these patients. Materials and Methods:We discuss approaches to the diagnosis and treatment of refractory ascites after liver transplant, based on a literature review, with a primary focus on vascular causes. These approaches are illustrated by case examples highlighting our experiences at an academic tertiary medical center. We propose a clinical practice algorithm for optimal endovascular treatment of refractory ascites after liver transplant. Results: The cornerstone of refractory ascites care is diagnosis and treatment of the cause. Vascular causes are not infrequently encountered and, if not treated early, are associated with graft loss and high morbidity and mortality and are major indications for retransplant. For patients with recurrent disease or graft rejection needing large volume paracentesis, the use of a transjugular intrahepatic portosystemic shunt may serve as a bridge to more definitive treatment (retransplant), although it may not be as effective for managing ascites as splenic artery embolization, arguably underused, which is emerging as a potential alternative treatment option. Conclusions: A multidisciplinary strategy for the diagnosis and care of patients with refractory ascites after liver transplant is crucial, with endovascular treatment playing an important role. The aim is for this document to serve as a concise and informative reference to be used by those who may care for patients with this rare yet serious diagnosis.

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Section: Hepatic Vein Stenosismentioning

confidence: 99%

Section: Hepatic Vein Stenosismentioning

confidence: 99%

Section: Portal Vein Stenosismentioning

confidence: 99%