Percutaneous Treatment of Portal Venous Stenosis in Children and Adolescents with Segmental Hepatic Transplants: Long-term Results

Funaki, Brian; Rosenblum, Jordan D.; Leef, Jeffrey A.; Zaleski, George X.; Farrell, Thomas J.; Lorenz, Jonathan M.; Brady, Lynda

doi:10.1148/radiology.215.1.r00ap38147

Cited by 167 publications

(208 citation statements)

References 12 publications

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“…In order to prevent post-interventional bleeding from the puncture tract 1) it is recommended to puncture the intrahepatic portal vein system as peripherally as possible (in this way the risk of arterial bleeding is minimized), and 2) embolization of the puncture tract has been performed, e. g. by cylinders of collagen, coils, N-butyl cyanoacrylate, Gelfoam and Gelfoam cubes [1 -5, 7]. In several studies there were no postinterventional bleeding complications [1, 3, 11], even when the puncture tract was not embolized [11]. However, in other studies bleeding complications were reported: 1) Cheng et al…”

mentioning

confidence: 99%

Percutaneous Transhepatic and Transsplenic Portal Vein Access: Embolization of the Puncture Tract Using Amplatzer Vascular Plugs

Dollinger¹,

Goessmann²,

Mueller-Wille³

et al. 2013

Fortschr Röntgenstr

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Purpose: To report on first results of the embolization of transhepatic and transsplenic puncture tracts using an Amplatzer Vascular Plug (AVP) after percutaneous portal vein intervention. Materials and Methods: Embolization of transhepatic and transsplenic puncture tracts with AVP was attempted in 5 patients (3 females; age range: 3???71 years). Portal vein access was gained by a transhepatic (n?=?4) or transsplenic (n?=?1) approach, and stenosis (n?=?2) or thrombosis (n?=?3) of the portal vein was successfully treated by percutaneous stenting or thrombus aspiration and thrombolysis using 6 to 10 French sheaths. Due to the relatively large bore and/or short transparenchymal puncture tracts, it was considered favorable to use AVPs as an embolic agent. The medical records, the radiological reports and images of these 5 patients were retrospectively evaluated. Result: In three cases one AVP II (diameter, 4?mm), in one case one AVP IV (diameter, 4?mm) and in one case two AVPs II (diameter, 8 and 6?mm) were used for embolization of the puncture tract. In all five cases embolization was technically successful. There was no bleeding from the puncture tract. During a median follow-up of 14 months (range, 21 days to 21 months), one patient developed a focal liver abscess adjacent to the AVP which was successfully treated by antimicrobial and drainage therapy. There were no further embolization-related complications. Conclusion: AVPs are suited to embolize large bore and/or short transhepatic and transsplenic puncture tracts effectively, safely, and precisely. Caution is required in patients with an increased risk for infectious complications. Key Points: ??Embolization of transhepatic and transsplenic puncture tracts with AVPs is feasible ??Large and/or short puncture tracts can be effectively embolized with AVPs ??The risk of infectious complications has to be considered Citation Format: ??Dollinger M, Goessmann H, Mueller-Wille R et?al. Percutaneous Transhepatic and Transsplenic Portal Vein Access: Embolization of the Puncture Tract Using Amplatzer Vascular Plugs. Fortschr R?ntgenstr 2014; 186: 142???150

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mentioning

confidence: 99%

Percutaneous Transhepatic and Transsplenic Portal Vein Access: Embolization of the Puncture Tract Using Amplatzer Vascular Plugs

Dollinger¹,

Goessmann²,

Mueller-Wille³

et al. 2013

Fortschr Röntgenstr

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“…10 For a residual significant stenosis or a recurrent stenosis within a few months after balloon angioplasty, the metallic stent placement should be considered. 11,12 However, there is a retransplantation case report about graft failure caused by portal thrombus after the placement of a portal vein stent for portal stenosis. 13 Measuring the long-term outcomes of larger patient pools is necessary for evaluation of portal vein stent for portal stenosis after liver transplantation.…”

Section: 5mentioning

confidence: 99%

Successful Treatment by Balloon Angioplasty Under Portography for Late-Onset Stenosis of Portal Vein After Cadaveric Liver Transplantation

Shiba

Sadaoka

Wakiyama

et al. 2013

International Surgery

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A 69-year-old woman, who underwent cadaveric liver transplantation for non-B, non-C liver cirrhosis with hepatocellular carcinoma in April 2009, was admitted to our hospital because of graft dysfunction. Enhanced computed tomography revealed stenosis of the left branch of the portal vein, obstruction of the right branch of the portal vein at porta hepatis, and esophagogastric varices. Balloon angioplasty of the left branch of the portal vein under transsuperior mesenteric venous portography was performed by minilaparotomy. After dilatation of the left branch of the portal vein, the narrow segment of the portal vein was dilated, which resulted in reduction of collateral circulation. At 7 days after balloon angioplasty, esophageal varices were improved. The patient made a satisfactory recovery, was discharged 8 days after balloon angioplasty, and remains well.

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“…The placement of metallic stents also has been reported for treatment of recurrent or nonresponsive elastic stenosis (Funaki et al, 2000;Zajko et al, 1994). In the largest patient series for which data are available, a very good patency rate of 100% was found at 46 months after treatment with angioplasty and metallic stent placement (Funaki et al, 2000). A transhepatic puncture of the portal vein is performed with a 21-gauge needle while using US for guidance.…”

Section: Portal Vein Stenosismentioning

confidence: 99%

“…14). The persistence of a pressure gradient of more than 5 mm Hg has been considered an indication for metallic stent placement (Funaki et al, 2000). Coil or gelfoam embolization of transhepatic needle tracts can be done to reduce the risk of bleeding.…”

Section: Portal Vein Stenosismentioning

confidence: 99%

Minimal Invasive (Endovascular and Percutaneous) Treatment of Post Liver Transplantation Complications in Pediatrics

Kroma¹,

Lopera²,

Suri³

2012

Liver Transplantation - Technical Issues and Complications

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Percutaneous Treatment of Portal Venous Stenosis in Children and Adolescents with Segmental Hepatic Transplants: Long-term Results

Cited by 167 publications

References 12 publications

Percutaneous Transhepatic and Transsplenic Portal Vein Access: Embolization of the Puncture Tract Using Amplatzer Vascular Plugs

Percutaneous Transhepatic and Transsplenic Portal Vein Access: Embolization of the Puncture Tract Using Amplatzer Vascular Plugs

Successful Treatment by Balloon Angioplasty Under Portography for Late-Onset Stenosis of Portal Vein After Cadaveric Liver Transplantation

Minimal Invasive (Endovascular and Percutaneous) Treatment of Post Liver Transplantation Complications in Pediatrics

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