Trans-splenic Access for Portal Venous Interventions in Children: Do Benefits Outweigh Risks?

Pimpalwar, Sheena; Chinnadurai, Ponraj; Hernandez, Alberto D.; Kukreja, Kamlesh; Siddiqui, Shakeel; Justino, Henri

doi:10.1007/s00270-017-1756-4

Cited by 23 publications

(45 citation statements)

References 27 publications

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“…TIPS placement has been accepted for the prevention of variceal bleeding and management of refractory ascites. Transplenic access into the portal system for placement of intrahepatic portosystemic shunt has been increasingly used to recanalize the portal vein, and has a high success rate 70,71. Kallini et al 70 reported the placement of TIPS through the transplenic approach in five symptomatic, noncirrhotic patients with complete occlusive chronic PVT, having durable patency rate and providing symptom alleviation.…”

Section: Interventionsmentioning

confidence: 99%

Update on Management of Portal Vein Thrombosis and the Role of Novel Anticoagulants

Wu¹,

Schuster²,

Tadros³

2019

Journal of Clinical and Translational Hepatology

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The clinical management of portal vein thrombosis (PVT) remains ambiguous due to its heterogeneous presentations and its associations with liver disease, malignancy, and hypercoagulable states. The natural history and clinical outcome of PVT are highly variable, dependent upon size, extent and degree of the thrombotic occlusion, as well as the physiological impact of patient comorbidities. While existing clinical guidelines consistently recommend low molecular weight heparin or vitamin K antagonist anticoagulation in cirrhotic patients with symptomatic acute PVT, management of asymptomatic and chronic PVT may need to be determined on a case-by-case basis, factoring in the state of underlying liver disease. In general, patients with PVT and underlying malignancy should be anticoagulated to alleviate symptoms and prevent recurrences that could disrupt the cancer management. However, existing clinical data does not support routine anticoagulation of cirrhotic patients with asymptomatic PVT in the absence of underlying cancer. While low molecular weight heparin and vitamin K antagonist remain the most commonly used agents in PVT, an emerging body of clinical evidence now suggests that direct-acting oral anticoagulants may be used safely and effectively in PVT. As such, direct-acting oral anticoagulants may offer a more convenient anticoagulation alternative for PVT management in future practice.

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Section: Interventionsmentioning

confidence: 99%

Update on Management of Portal Vein Thrombosis and the Role of Novel Anticoagulants

Wu¹,

Schuster²,

Tadros³

2019

Journal of Clinical and Translational Hepatology

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“…30 A higher complication rate of transsplenic access is reported, specifically a 27% complication rate (12/44 patients) due to intraperitoneal bleeding; however, all patients were managed supportively with none requiring splenectomy or splenic artery embolization. 29 Ohm et al identified a lower transsplenic complication rate of 10% (1/10). 25 Routine use gelfoam, coils, or a combination thereof, to embolize transhepatic and transsplenic access routes, is recommended.…”

Section: Treatment Outcomes and Complicationsmentioning

confidence: 97%

“…3,5,24,27 Recently, the safety and efficacy of a transsplenic approach was recognized. 25,28,29 Mechanical advantages of the trans-splenic approach are similar to transhepatic, with the additional benefit of avoiding further graft injury. Moreover, a transsplenic approach is preferred, with variant anatomy of a left lobe transplant, attenuation of intrahepatic PV branches, or cavernous transformation of the main portal vein.…”

Section: Imaging Workupmentioning

confidence: 99%

Portal Venous Interventions after Liver Transplant

Mahon

Molvar

2019

Dig Dis Interv

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Liver transplant (LT) recipients are a challenging patient population when presenting with graft dysfunction or sequelae of portal hypertension. When no medical causes for graft dysfunction are found, a hemodynamically significant vascular lesion is suspected. Although rare, a variety of diseases may arise involving the portal system, which inhibit flow and graft function. Herein, we present a review of portal venous interventions performed in the LT setting, with focus on imaging diagnosis, endovascular treatment techniques, and outcomes. Entities addressed include portal venous stenosis, portal venous thrombosis, and recurrent fibrosis/cirrhosis with sequelae of portal hypertension.

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“…9a-f) demonstrated success in treating eight patients with Roux limb varices; however, intraperitoneal bleeding occurred in 27% of patients with a significant correlation between hemorrhage and intraprocedural anticoagulation. 70 The majority of published case reports and small case series of successful management of bleeding jejunal varices in adults are in patients with prior liver transplant, extrahepatic portal venous obstruction, or hepatopancreatobiliary surgery (commonly choledocojejunostomy) which suggests an altered venous collateralization pathway postprocedurally leading to varices at the jejunal anastamosis. 59,[71][72][73][74][75] There are only three cases reported of adults patients with bleeding jejunal varices without portal hypertension or prior surgery, 76 and none in the pediatric literature.…”

Section: Small Bowel and Roux Limb Varicesmentioning

confidence: 99%

Endovascular and Percutaneous Treatment of Pediatric Portosystemic Varices: A Case Review

et al. 2019

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Portal hypertension is a significant cause of morbidity and mortality in pediatric patients. Complications of portal hypertension include development of portosystemic varices. The most common type of portosystemic varices are gastroesophageal varices; however, other ectopic varices can also be a cause of recurrent, life-threatening gastrointestinal bleeding. Problematic ectopic varices include isolated gastric, anorectal, small bowel, roux-limb, and stomal varices. There are no standardized treatment guidelines on how to manage ectopic varices in children; however, new innovations in endovascular treatment options provide potential therapeutic alternatives when varices are refractory to conventional therapy. This review provides a case-based literature review for endovascular treatment of isolated gastric, anorectal, small bowel, roux-limb, and stomal ectopic varices in children (age 0-9 years) and adolescents (age 10-19 years).

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Trans-splenic Access for Portal Venous Interventions in Children: Do Benefits Outweigh Risks?

Abstract: Trans-splenic access is a useful technique for successful pediatric portal interventions. Although it entails a substantial risk of intraperitoneal bleeding, this can be managed conservatively.

Cited by 23 publications

References 27 publications

Update on Management of Portal Vein Thrombosis and the Role of Novel Anticoagulants

Update on Management of Portal Vein Thrombosis and the Role of Novel Anticoagulants

Portal Venous Interventions after Liver Transplant

Endovascular and Percutaneous Treatment of Pediatric Portosystemic Varices: A Case Review

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