Effective Endovascular Stenting of Malignant Portal Vein Obstruction in Pancreatic Cancer

Abstract

We report herein the case of a patient successfully treated by transhepatic portal venous stent placement for malignant portal vein obstruction with associated gastric and small bowel varices and repeated gastrointestinal bleeding. CT angiography and portography showed severe portal vein obstruction from recurrent pancreatic cancer 15 months following pancreaticoduodenectomy with tumor encasement and dilated collateral veins throughout the gastric and proximal small bowel wall as the suspected cause of the GI bleeding. Successful transhepatic endovascular stent placement of the splenic vein at the portal vein confluence followed by balloon dilation was performed with immediate decompression of the gastric and small bowel varices and relief of GI hemorrhage in this patient until his death four months later. The treatment for patients with this dilemma can prove to be difficult, but as we have shown endovascular stenting of the portal system is an effective treatment option.

Portal vein stenting in the management of duodenal varices due to malignant obstruction: A case report and literature review

“…The role of coil embolization and further trans-hepatic PV stenting has been demonstrated to be effective in this case of malignant obstruction of the PV. Other similar cases put forward show an important role for stenting with minimal representations due to further gastro-intestinal bleeding seen within the literature [19] , [20] . The role of stenting for the management of PV obstruction should be further investigated by prospective clinical trials.…”

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

“…Its role is limited due to advances in percutaneous endovascular techniques. Transhepatic PV stenting has been described widely to treat strictures following liver transplantation 3 and, occasionally, as palliation 4 or as part of curative treatment 5 for hepatopancreatobiliary malignant disease. The use of PV stenting in the present case permitted resolution of portal hypertension and decreased the risk associated with performing surgical hepaticojejunostomy, a very difficult operation in the presence of hilar varices.…”

Persistent severe gastrointestinal bleeding in a man with metastatic somatostatinoma

“…BRTO and/or percutaneous transhepatic obliteration is occasionally effective 1 2. Endovascular stenting has been used successfully3 4 and should be considered where other methods are not feasible or have failed, even in patients with cavernous transformation of the PV. Similarly, transjugular intrahepatic postosystemic shunt can be used to treat PV thrombosis with and without cavernous transformation, but is technically difficult especially with co-existing SMV thrombosis 5.…”