Treatment of Inferior Vena Cava Obstruction Following Pediatric Liver Transplantation: Novel Use of a Customized Endovascular Stent

Averin, Konstantin; Bucuvalas, John C.; Alonso, M. Henar; Kohli, Rohit; Heubi, James E.; Johnson, Neil; Goldstein, Bryan H.

doi:10.1016/j.jpeds.2016.09.051

Cited by 2 publications

(4 citation statements)

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“…In the paediatric population, inferior caval vein stenosis is very rare and more typically encountered following cardiothoracic or abdominal surgeries such as heart or liver transplant. [2][3][4][5][6] Our patient developed severe inferior caval vein stenosis following severe abdominal trauma leading to significantly impaired lymphatic drainage and very difficult to manage chylothorax and chyloperitoneum that resolved completely following stent placement. Although off label, bare metal open cell stents, such as the 26 mm EV3 LD Max stent, are commonly use in the field of interventional paediatric cardiology to address congenital and acquired stenosis such as aortic coarctations and branch pulmonary artery stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…Stenosis secondary to injury is even more rare in this population and most reported case describe inferior caval vein stenosis discovered in the postoperative period either after congenital heart surgery or liver transplant. [2][3][4][5][6] In the Adult a literature, inferior caval vein injury, although rare, is more commonly reported and is typically secondary to penetrating injury requiring surgical management with a high mortality. 10 We report a rare case of a 5-year-old male with severe inferior caval vein stenosis secondary to a fall injury successfully treated with transcatheter stent implantation.…”

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Transcatheter stent implantation in a child with severe stenosis of the inferior caval vein secondary to injury

et al. 2021

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Stenosis of the Inferior Caval Vein is rarely encountered in the paediatric setting. A 5-year-old male sustained severe injuries secondary to a fall from a three story balcony and was subsequently found to have severe stenosis of the inferior caval vein resulting in extensive lymphatic drainage with chylothorax, chyloperitoneum, and severe abdominal ascites. This was successfully treated with transcatheter stent placement resulting in complete resolution of the stenosis and significant clinical improvement allowing for transfer to a rehabilitation centre and eventual discharge home.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Transcatheter stent implantation in a child with severe stenosis of the inferior caval vein secondary to injury

et al. 2021

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“…At present, endovascular treatment, including percutaneous balloon angioplasty and stent placement, is the preferred treatment for HVOO after liver transplantation[ 14 ]. However, it remains unclear whether balloon angioplasty or stent placement is preferable[ 10 , 11 , 15 ]. Kubo et al[ 16 ] performed endovascular treatments in 20 patients with HVOO after liver transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…Although insufficient evidence has been obtained to support the benefits of stent placement for HVOO, novel stenting devices, such as drug-eluting and biodegradable stents, may be promising for the management of HVOO. Averin et al[ 15 ] reported the use of a customized endovascular stent for the treatment of inferior vena cava obstruction following pediatric liver transplantation, in an attempt to relieve the risk of hepatic venous vein egress. However, the long-term efficacy of endovascular stent placement remains unproven.…”

Section: Discussionmentioning

confidence: 99%

Balloon dilatation for treatment of hepatic venous outflow obstruction following pediatric liver transplantation

Zhang¹,

Jin²,

Chen³

et al. 2017

WJG

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AIMTo assess the efficacy and safety of balloon dilatation for the treatment of hepatic venous outflow obstruction (HVOO) following pediatric liver transplantation.METHODSA total of 246 pediatric patients underwent liver transplantation at our hospital between June 2013 and September 2016. Among these patients, five were ultimately diagnosed with HVOO. Seven procedures (two patients underwent two balloon dilatation procedures) were included in this analysis. The demographic data, types of donor and liver transplant, interventional examination and therapeutic outcomes of these five children were analyzed. The median interval time between pediatric liver transplantation and balloon dilatation procedures was 9.8 mo (range: 1-32).RESULTSFive children with HVOO were successfully treated by balloon angioplasty without stent placement, with seven procedures performed for six stenotic lesions. All children underwent successful percutaneous intervention. Among these five patients, four were treated by single balloon angioplasty, and these patients did not develop recurrent stenosis. In seven episodes of balloon angioplasty across the stenosis, the pressure gradient was 12.0 ± 8.8 mmHg before balloon dilatation and 1.1 ± 1.5 mmHg after the procedures, which revealed a statistically significant reduction (P < 0.05). The overall technical success rate among these seven procedures was 100% (7/7), and clinical success was achieved in all five patients (100%). The patients were followed for 4-33 mo (median: 15 mo). No significant procedural complications or procedure-related deaths occurred.CONCLUSIONBalloon dilatation is an effective and safe therapeutic option for HVOO in children undergoing pediatric liver transplantation. Venous angioplasty is also recommended in cases with recurrent HVOO.

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Treatment of Inferior Vena Cava Obstruction Following Pediatric Liver Transplantation: Novel Use of a Customized Endovascular Stent

Cited by 2 publications

References 22 publications

Transcatheter stent implantation in a child with severe stenosis of the inferior caval vein secondary to injury

Transcatheter stent implantation in a child with severe stenosis of the inferior caval vein secondary to injury

Balloon dilatation for treatment of hepatic venous outflow obstruction following pediatric liver transplantation

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