Stent Placement for Portal Vein Stenosis After Pancreaticoduodenectomy

Hiyoshi, Masahide; Fujii, Yukihiko; Kondo, Kazuhiro; Imamura, Naoya; Nagano, Motoaki; Ohuchida, Jiro

doi:10.1007/s00268-015-3094-5

Cited by 19 publications

(17 citation statements)

References 47 publications

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“…This shows that PV stenting is effective in relieving PV stenosis after LT and HPB surgery. The results of this audit are comparable with other publications; [12,24,28] however, comparison must be done with caution as there are obvious inter-institutional differences in the postoperative follow-up and indication of PV stent placement. In our institution, patients with clinical and/or radiological signs of significant PV stenosis were subjected to PV stenting after evaluation by a multidisciplinary team.…”

Section: Discussionsupporting

confidence: 80%

“…With an increasing rate of surgical resection and vascular reconstruction in HPB surgery, an increasing incidence of complications related to the PV must be anticipated [15][16][17]. Percutaneous transhepatic stenting of the PV has gained acceptance as a safe minimally invasive procedure with promising results [12,[18][19][20][21][22][23][24]. The aim of this paper is to evaluate the results of stenting of PV stenosis after LT and HPB surgery within a high-volume tertiary referral center.…”

Section: Introductionmentioning

confidence: 99%

“…Potential symptoms related to PV stenosis are abdominal pain, liver failure, intractable ascites, and gastrointestinal bleeding [ 9 – 11 ] which render it as a potentially serious condition. Management of postoperative PV stenosis with percutaneous stent placement has previously been reported to be a viable and less invasive option than laparotomy and surgical revision [ 12 ]. Even though PV stenosis is a rare complication after LT [ 2 , 3 ], it has recently been shown to be as high as 19.6% after pancreatoduodenectomy [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Portal vein stent placement after hepatobiliary and pancreatic surgery

Khan

Kleive

Aandahl

et al. 2020

Langenbecks Arch Surg

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Purpose To evaluate the long-term outcomes of percutaneous transhepatic stent placement for portal vein (PV) stenosis after liver transplantation (LT) and hepato-pancreato-biliary (HPB) surgery. Methods Retrospective study of 455 patients who underwent LT and 522 patients who underwent resection of the pancreatic head between June 2011 and February 2016. Technical success, clinical success, patency, and complications were evaluated for both groups. Results A total of 23 patients were confirmed to have postoperative PV stenosis and were treated with percutaneous transhepatic PV stent placement. The technical success rate was 100%, the clinical success rate was 80%, and the long-term stent patency was 91.3% for the entire study population. Two procedure-related hemorrhages and two early stent thromboses occurred in the HPB group while no complications occurred in the LT group. A literature review of selected studies reporting PV stent placement for the treatment of PV stenosis after HPB surgery and LT showed a technical success rate of 78-100%, a clinical success rate of 72-100%, and a long-term patency of 57-100%, whereas the procedure-related complication rate varied from 0-33.3%. Conclusions Percutaneous transhepatic PV stent is a safe and effective treatment for postoperative PV stenosis/occlusion in patients undergoing LT regardless of symptoms. Due to increased risk of complications, the indication for percutaneous PV stent placement after HPB surgery should be limited to patients with clinical symptoms after an individual assessment.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Portal vein stent placement after hepatobiliary and pancreatic surgery

Khan

Kleive

Aandahl

et al. 2020

Langenbecks Arch Surg

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“…Portal venous stenosis occurs in approximately 12.4% of cases, and symptoms related to portal hypertension that require treatment occur in approximately 1.5%-2.8 % of cases after pancreatoduodenectomy [34,39]. Jejunal varices formed at the site of the choledochojejunostomy are often difficult to detect and treat by gastrointestinal endoscopy [3].…”

Section: Discussionmentioning

confidence: 99%

Portal Vein Stenting for Jejunal Variceal Bleeding after Recurrence of Pancreatic Adenocarcinoma: A Case Report and Review of the Literature

Sugiyama

Hirakawa

Takeishi

et al. 2021

Interventional Radiology

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A 73-year-old woman with portal vein stenosis caused by tumor recurrence after pancreatoduodenectomy was treated with stent placement without embolization of the jejunal varix. Anticoagulation therapy using heparin followed by rivaroxaban was administered after the procedure. She continued to receive systemic chemotherapy as an outpatient. Neither restenosis nor stent thrombosis was observed after 7 months. Based on the presented case and literature review, portal vein stenting is an effective treatment option for jejunal variceal bleeding caused by malignant portal venous stricture after pancreaticoduodenectomy. Antithrombotic therapy following portal venous stenting is required to prevent stent thrombosis in the majority of cases, although it has a risk of inducing recurrent variceal bleeding. Adjunctive jejunal variceal embolization can possibly be omitted in selected cases to obtain sufficient portal-SMV flow reconstruction.

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“…Although portal vein resection is generally performed in patients with hepatobiliary pancreatic malignancies invading the portal vein at high-volume centers, 4 portal vein stenosis occurs after PD with an incidence of 2.4%. 5 Severe portal vein stenosis causes life-threatening clinical conditions such as hepatic encephalopathy due to decreased portal flow into the liver, variceal bleeding from the digestive tract, and ascites due to portal hypertension and liver failure. 6 Therefore, portal vein stenosis must be treated when it occurs with these complications.…”

Section: Discussionmentioning

confidence: 99%

Portal Vein Stenting for Portal Vein Stenosis After Pancreatoduodenectomy: A Case Report

et al. 2018

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Portal vein stenosis, which results in serious clinical conditions such as gastrointestinal variceal bleeding and liver failure, is caused by hepatobiliary pancreatic cancer or major postoperative complications after hepatobiliary pancreatic surgery. In recent years, portal vein stenting under interventional radiology has been applied as a more useful treatment method for portal vein stenosis than invasive surgery. We herein report the successful use of a vascular stent for portal vein stenosis after pancreatoduodenectomy. A 66-year-old man with distal cholangiocarcinoma underwent subtotal stomach-preserving pancreatoduodenectomy with resection of the portal vein because of direct invasion to the main portal vein at our hospital. The portal vein was reconstructed without a venous graft. He developed jejunal bleeding near the pancreatojejunostomy on postoperative day (POD) 2. Although embolization of the responsible vessel achieved hemostasis, an intraoperatively inserted drainage tube was needed for a long period of time postoperatively because the embolized afferent jejunum was perforated. He was discharged on POD 39 after removal of the drainage tube. On POD 282, he was readmitted with melena and severe fatigue. Computed tomography revealed an obstruction of the reconstructed portal vein and varices at the hepaticojejunostomy site. We diagnosed variceal bleeding and performed percutaneous transhepatic stenting in the obstructed portal vein. The patient was discharged in good clinical condition on day 15 after stenting. In conclusion, portal vein stenting is a useful and less invasive therapy for portal vein stenosis.

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Stent Placement for Portal Vein Stenosis After Pancreaticoduodenectomy

Abstract: Percutaneous stent placement is viable, less invasive option than laparotomy for the management of PV stenosis after PD.

Cited by 19 publications

References 47 publications

Portal vein stent placement after hepatobiliary and pancreatic surgery

Portal vein stent placement after hepatobiliary and pancreatic surgery

Portal Vein Stenting for Jejunal Variceal Bleeding after Recurrence of Pancreatic Adenocarcinoma: A Case Report and Review of the Literature

Portal Vein Stenting for Portal Vein Stenosis After Pancreatoduodenectomy: A Case Report

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