Interventional Radiological Management of Prehepatic Obstruction the Splanchnic Venous System

Semiz-Oysu, Aslıhan; Keussen, Inger; Cwikiel, Wojciech

doi:10.1007/s00270-007-9097-3

Cited by 45 publications

(19 citation statements)

References 14 publications

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“…A single session of treatment with PV stent placement may constitute an alternative. Since the early 1990s, only a few case reports or case series addressed stent placement for treatment of benign PV thrombosis [2], stenosis, or occlusion due to chronic or acute pancreatitis [3][4][5][6][7], coagulation disorder [8], or complications related to liver transplantation or other surgeries [9][10][11][12][13]. Stent placement to treat malignant PV lesion has been also evaluated [10,[14][15][16][17][18][19][20][21][22], mainly by Yamakado et al [14][15][16], who published three studies that followed a cohort of patients who presented with biliary or pancreatic neoplasms, and HCC.…”

Section: Introductionmentioning

confidence: 99%

Palliative Portal Vein Stent Placement in Malignant and Symptomatic Extrinsic Portal Vein Stenosis or Occlusion

Novellas

Denys

Bize

et al. 2008

Cardiovasc Intervent Radiol

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This article evaluates the results of portal vein (PV) stent placement in patients with malignant extrinsic lesions stenosing or obstructing the PV and causing symptomatic PV hypertension (PVHT). Fourteen patients with bile duct cancer (n = 7), pancreatic adenocarcinoma (n = 4), or another cancer (n = 3) underwent percutaneous transhepatic portal venous stent placement because of gastroesophageal or jejunal varices (n = 9), ascites (n = 7), and/or thrombocytopenia (n = 2). Concurrent tumoral obstruction of the main bile duct was treated via the transhepatic route in the same session in four patients. Changes in portal venous pressure, complications, stent patency, and survival were evaluated. Mean ± standard deviation (SD) gradient of portal venous pressure decreased significantly immediately after stent placement from 11.2 mmHg ± 4.6 to 1.1 mmHg ± 1.0 (P \ 0.00001). Three patients had minor complications, and one developed a liver abscess. During a mean ± SD follow-up of 134.4 ± 123.3 days, portal stents remained patent in 11 patients (78.6%); stent occlusion occurred in 3 patients, 2 of whom had undergone previous major hepatectomy. After stent placement, PVHT symptoms were relieved in four (57.1%) of seven patients who died (mean survival, 97 ± 71.2 days), and relieved in six (85.7%) of seven patients still alive at the end of follow-up (mean follow-up, 171.7 ± 153.5 days). Stent placement in the PV is feasible and relatively safe. It helped to relieve PVHT symptoms in a single session.

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Section: Introductionmentioning

confidence: 99%

Palliative Portal Vein Stent Placement in Malignant and Symptomatic Extrinsic Portal Vein Stenosis or Occlusion

Novellas

Denys

Bize

et al. 2008

Cardiovasc Intervent Radiol

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“…This is a relatively low-risk procedure, is noninvasive, and if it fails it does not eliminate future surgical options. 21,22 Given the low risk and potentially high yield of these procedures, they can be considered in children without clear indications for surgical intervention that have a favorable anatomy. If this procedure fails, then continued observation seems appropriate for the majority of patients, unless they develop significant complications of portal hypertension.…”

Section: Figurementioning

confidence: 99%

Progression of Noncirrhotic Portal Hypertension in a Pediatric Population

Wojcik¹,

Zahid²,

Cai³

et al. 2011

Journal of Clinical and Experimental Hepatology

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P ortal hypertension is classically caused by cirrhotic liver disease. However, there are several etiologies of portal hypertension that do not coincide with liver failure. Noncirrhotic portal hypertension may manifest clinically by upper gastrointestinal (GI) bleeding from esophageal varices, leukopenia, and thrombocytopenia from splenomegaly. 1,2 While studies have shown that certain liver functions are affected as a result of reduced portal venous flow, ascites and clinical encephalopathy are not common given the lack of intrinsic liver dysfunction.1-8 Noncirrhotic etiologies of portal hypertension are classified as prehepatic, hepatic, and posthepatic. Prehepatic causes are associated with thrombosis within the portal venous system. Hepatic causes include noncirrhotic portal fibrosis and schistosomiasis. Finally, Budd-Chiari syndrome, inferior vena cava (IVC) thrombosis/occlusion, and constrictive pericarditis are posthepatic etiologies of portal hypertension.In pediatric patients, portal vein thrombosis (PVT), or extrahepatic portal vein obstruction (EHPVO), is the most common cause of noncirrhotic portal hypertension. The pathophysiology of PVT is poorly understood, although studies have identified several pre-disposing factors, including neonatal umbilical vein catheterization and hypercoagulable states.9,10 Indications for surgical intervention on these complex children are controversial, but include refractory variceal hemorrhage, severe thrombocytopenia, severe leukopenia, encephalopathy, and porto-pulmonary hypertension.2 There are various surgical interventions available that attempt to improve the portal flow, including the meso-Rex bypass, 11 distal splenorenal shunt, 12,13 splenectomy followed by proximal splenorenal shunt, and the mesocaval shunt. 14 The aforementioned procedures are all significant operations and have a broad range of potential complications, including shunt thrombosis. Consideration of these risks is important, given that many patients have been reported to do well long-term without any surgical intervention. 1,15While surgery is often recommended following a GI bleed requiring blood transfusion, specific indications for surgical intervention are unclear. Further, with the development of advanced endovascular techniques, clinical decision-making has become even more complex. We have recently established a pediatric portal hypertension program at our institution, which includes hepatologists, interventional radiologists, radiologists, and surgeons. As we develop our own protocols for the management of children with noncirrhotic portal hypertension, we have reviewed Background/Objectives: The optimal management of children with noncirrhotic portal hypertension is controversial. Some groups suggest early and aggressive surgical intervention, while others report long-term success with conservative management. Methods: We conducted a retrospective study of 26 patients with noncirrhotic portal hypertension treated at our institution. We compared platelet counts, white blood cell (WBC...

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“…The use of TIPS was associated with immediate symptomatic improvement and successful recanalization in 83% of patients treated. 39 Two cases, one with extensive portal, mesenteric and splenic vein thrombosis and another with mesenteric and portal vein thrombosis have been reported to have favorable outcomes with TIPS. 40 A retrospective study on 20 patients with portal vein thrombosis (PVT) suggested a high success rate in cases of non-cavernous PVT and it was effective in prevention of variceal bleeding and recurrent ascites.…”

Section: Interventional Radiological Optionsmentioning

confidence: 99%

Mesenteric Venous Thrombosis

Singal

Kamath

Tefferi

2013

Mayo Clinic Proceedings

193

198

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Interventional Radiological Management of Prehepatic Obstruction the Splanchnic Venous System

Abstract: We conclude that interventional procedures can be successfully performed in the majority of patients with obstruction of splanchnic veins, with subsequent improvement of symptoms. Treatment should be customized according to the site and nature of obstruction.

Cited by 45 publications

References 14 publications

Palliative Portal Vein Stent Placement in Malignant and Symptomatic Extrinsic Portal Vein Stenosis or Occlusion

Palliative Portal Vein Stent Placement in Malignant and Symptomatic Extrinsic Portal Vein Stenosis or Occlusion

Progression of Noncirrhotic Portal Hypertension in a Pediatric Population

Mesenteric Venous Thrombosis

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