Successful Portal Vein Stent Placement in a Child with Cavernomatous Replacement of the Portal Vein After Partial Liver Transplantation: The Importance of a Recognizable Portal Vein Remnant

Miraglia, Roberto; Maruzzelli, Luigi; Caruso, Settimo; Ricotta, Calogero; Riva, Silvia; Burgio, Gaetano; Spada, Marco; Luca, Angelo

doi:10.1007/s00270-015-1084-5

Cited by 3 publications

(10 citation statements)

References 12 publications

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“…PVS intervention may be more suitable for non-cirrhotic patients than mTIPS because it preserves adequate physiological blood inflow to the liver. However, it is reasonable to be aware of the possibility of catheterizing the portal vein remnant and the patency of the major splanchnic vessels by Doppler ultrasound and CT ( 99 ). A new classification for CTPV proposed by Marot et al was formulated with the aim of selecting which patients could be considered for portal angioplasty.…”

Section: Interventional Vascular Therapiesmentioning

confidence: 99%

Optimal Treatment for Patients With Cavernous Transformation of the Portal Vein

2022

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Cavernous transformation of the portal vein (CTPV) is a sequela of extrahepatic and/or intrahepatic portal vein obstruction caused by a combination of local and risk factors. It was ever taken as a relatively rare disease due to its scant literature, which was mainly based on clinical series and case reports. CTPV often manifests as gastroesophageal variceal bleeding, splenomegaly, and portal biliopathy after the long-term insidious presentation. It is unable for CTPV to be recanalized with anticoagulation because it is a complete obstruction of the mesentericoportal axis. Endoscopic therapy is mainly used for temporary hemostasis in acute variceal bleeding. Meso-Rex shunting characterized by portal-flow-preserving shunts has been widely performed in children with CTPV. The multitude of complications associated with CTPV in adults can be effectively addressed by various interventional vascular therapies. With the ubiquity of radiological examinations, optimal treatment for patients with CTPV becomes important. Multivisceral transplantation, such as liver-small intestinal transplantation, may be lifesaving and should be considered for patients with diffuse mesenteric venous thrombosis.

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Section: Interventional Vascular Therapiesmentioning

confidence: 99%

Optimal Treatment for Patients With Cavernous Transformation of the Portal Vein

2022

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“…As mentioned in 2000 by Tissieres et al, the role of the latter procedure is limited and palliative at best and is associated with encephalopathy and the need for re‐transplantation. Radiological recanalization has been proposed as an alternative with the placement of a long stent that would typically run from the spleno‐mesenteric confluence to the recessus of the Rex. There are many limitations to such a procedure, including difficult recanalization due to the natural curves of the PV reconstruction in the case of an LLSG and also the fact that the angioplasty and the stent diameters are limited by the small age of the patient.…”

Section: Discussionmentioning

confidence: 99%

“…As mentioned in 2000 by Tissieres et al 19 , the role of the latter procedure is limited and palliative at best and is associated with encephalopathy and the need for re-transplantation. Radiological recanalization has been proposed as an alternative 15,24,25 with the placement of a long stent that would typically run from the spleno-mesenteric confluence to the recessus of the Rex.…”

Section: Discussionmentioning

confidence: 99%

“…26,27 As the deterioration is progressive and because the surgery is increasingly demanding with time, these patients should be proposed for pre-emptive Meso-Rex bypass surgery early in the condition's evolution. 12,15,21,28 The role of radiological recanalization and stenting remains unclear in a population that consists mostly of young children, in whom growth may alter the stent's function.…”

Section: Discussionmentioning

confidence: 99%

“…(4) A fourth patient presented recurrent severe bleeding from the Roux loop and became dependent on somatostatin until he was cured by a Meso-Rex bypass. Two patients were proposed for successful elective interventions consisting of (1) a Meso-Rex bypass intervention (case 13) and (2) an interventional radiological recanalization of the PV remnant 18 months after LT, allowing for balloon angioplasty with the placement of an uncovered stent (8 mm diameter/57 mm) (Patient 12-Figure 1) 15. Although it was initially successful, the latter intervention was followed by a recurrence of the signs of a CEPH.…”

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confidence: 99%

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Unusual venous collateral pathways allow for reperfusion of the intrahepatic portal venous system in children with portal vein thrombosis after split liver transplantation: Clinical relevance and management implications

Mamone

Caruso

Francesco

et al. 2019

Pediatric Transplantation

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PVT is the most frequent vascular complication after LT in small children, and a higher incidence has been observed in those transplanted for biliary atresia or with a LLSG. Thrombosis of the PV causes extrahepatic portal hypertension and is associated with splenomegaly and the development of venous neo‐collaterals, including gastro‐oesophageal varices and splenorenal shunts. It has also been incidentally suggested in the literature that patients who have had a Roux‐en‐Y loop for a biliary reconstruction may present with a cavernomatous transformation of the distal portion of the loop. In this study, 13 children with CEPH caused by thrombosis of the PV after LT were analysed. The study evidenced the development of two types of hepatopetal venous networks: (a) a large cavernoma along the Roux loop and around the biliary anastomosis, and (b) a network of neo‐collaterals in the gastro‐duodeno‐pancreatic area that connected to the intrahepatic portal branches directly through the liver capsule. These hepatopetal venous networks between the venous system of the surrounding organs or the omentum and the intrahepatic portal branches can be identified by radiologists. The relevance for the transplanting physician and the transplant surgeon is discussed.

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Long-term efficacy and safety of anticoagulant for cavernous transformation of the portal vein cirrhotic patient with extrahepatic portal vein obstruction

Zhou

Zhuang

et al. 2023

Thrombosis J

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Background/aims Cavernous transformation of the portal vein (CTPV) in cirrhotic patients with extrahepatic portal vein obstruction (EHPVO) was a relatively rare disease and had no consensus on the treatment. Our study aimed to explore the value of anticoagulation with warfarin treatment for CTPV cirrhotic patients with EHPVO. Methods: From January 2015 to December 2019, the clinical characteristics of cirrhotic patients who were diagnosed as CTPV with EHPVO were retrospectively analyzed. Eligible patients were distributed into the anticoagulation group (n = 46) and control group (n = 38). The change of portal vein thrombosis, hepatic decompensation, survival and adverse events were evaluated between the two groups. Results The median follow-up of our patients was 51 months in the anticoagulation group and 44 months in the control group. The progress rate of the portal vein was higher in patients from the control groups (n = 12) than in patients from the anticoagulation group (n = 4, p = 0.008). There was no significant difference between the partial recanalization rate and stable rate between the two groups. Patients in anticoagulation group developed less hepatic decompensation than those in control group (13.0% vs 34.2%, p = 0.021). The Kaplan-Meier curve showed that patients in the anticoagulation group had a better prognosis than patients in the control group (P < 0.022). There were no serious complications due to warfarin treatment. Conclusion For CTPV cirrhotic patients with EHPVO, anticoagulation with warfarin treatment was effective and safe. Anticoagulants could prevent portal vein thrombosis progression, hepatic decompensation and death. In addition, our results showed little benefit of anticoagulants on thrombosis recanalization.

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Successful Portal Vein Stent Placement in a Child with Cavernomatous Replacement of the Portal Vein After Partial Liver Transplantation: The Importance of a Recognizable Portal Vein Remnant

Cited by 3 publications

References 12 publications

Optimal Treatment for Patients With Cavernous Transformation of the Portal Vein

Optimal Treatment for Patients With Cavernous Transformation of the Portal Vein

Unusual venous collateral pathways allow for reperfusion of the intrahepatic portal venous system in children with portal vein thrombosis after split liver transplantation: Clinical relevance and management implications

Long-term efficacy and safety of anticoagulant for cavernous transformation of the portal vein cirrhotic patient with extrahepatic portal vein obstruction

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