Portomesenteric Venous Stenting for Palliation of Ascites and Variceal Bleeding Caused by Prehepatic Portal Hypertension

Sheth, Rahul A.; Sabir, S.; Parmet, P.; Amin, Roshon; Kuban, Joshua D.; Huang, Steven Y.; Mahvash, Armeen; Fogelman, David R.; Javle, Milind; Wallace, Michael J.

doi:10.1634/theoncologist.2017-0337

Cited by 9 publications

(9 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The placement of a 10-mm-diameter, 27-mm-long noncovered stent (not shown) in the MPV resulted in a pressure gradient of 2 mm Hg. high technical and clinical success in the setting of PV stenosis after organ transplantation and for palliation in the setting of extrinsic malignant compression of the PV (19)(20)(21)(22). However, there are fewer data on the outcomes of PMV venoplasty and stent placement following pancreatic surgery in this era of expanding neoadjuvant and adjuvant oncologic therapies and major vascular reconstruction (21,23,24).…”

Section: Percutaneous Pmv Interventionmentioning

confidence: 99%

Portomesenteric Venous Complications after Pancreatic Surgery with Venous Reconstruction: Imaging and Intervention

et al. 2020

View full text Add to dashboard Cite

Pancreatic surgery with en bloc venous resection and reconstruction is becoming increasingly common in the current era of expanding neoadjuvant oncologic therapies and advanced surgical techniques for patients with more anatomically complex tumors. However, patients who have alterations in their venous outflow are at increased risk for postoperative portomesenteric venous stenosis and/or thrombosis. Cross-sectional imaging for postoperative surveillance, including multiphase CT or MRI, is critical for recognizing portomesenteric venous complications and thus implementing early intervention and preventing complications related to portomesenteric venous hypertension. Hypertension-related complications include ascites, variceal or gastrointestinal bleeding, postprandial abdominal pain, intestinal edema, protein-losing enteropathy, malabsorptive diarrhea, and splenomegaly. Percutaneous transhepatic, transsplenic, and transjugular portomesenteric interventions, including venoplasty, stent placement, and thrombectomy or thrombolysis, are safe and effective options for restoring patency to the portomesenteric venous system. Preintervention CT or MRI and diagnostic catheter venography are important for procedural planning, while postintervention CT or MRI surveillance is critical for detecting recurrent stenosis or thrombosis, or de novo portomesenteric venous disease.

show abstract

Section: Percutaneous Pmv Interventionmentioning

confidence: 99%

Portomesenteric Venous Complications after Pancreatic Surgery with Venous Reconstruction: Imaging and Intervention

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The use of anticoagulant and antiplatelet agents remains controversial because they increase the risk of variceal bleeding and coagulopathy in many patients. Physicians favor the use of these agents because recanalization of thrombotic occlusion is technically challenging [ 5 7 ]. A stratified randomized, controlled study is needed to further evaluate the benefits of using anticoagulant and antiplatelet agents.…”

Section: Discussionmentioning

confidence: 99%

“…Portal hypertension can present as ascites, congestive enteropathy, variceal bleeding, or hypersplenism [ 3 ]. PV stents are usually inserted to relieve portal hypertension in symptomatic patients, and several studies have demonstrated their effect [ 3 4 5 ]. Because cavernous transformation followed by PV occlusion could preserve the function of the liver in non-oncologic patients, the importance of the PV flow may be underestimated.…”

Section: Introductionmentioning

confidence: 99%

Effect of Stent Placement on Survival in Patients with Malignant Portal Vein Stenosis: A Propensity Score–Matched Study

Shim

Kim

et al. 2022

Korean J Radiol

View full text Add to dashboard Cite

Objective Percutaneous portal vein (PV) stent placement can be an effective treatment for symptoms associated with portal hypertension. This study aimed to evaluate the effect of PV stenting on the overall survival (OS) in patients with malignant PV stenosis. Materials and Methods Two groups of patients with malignant PV stenosis were compared in this retrospective study involving two institutions. A total of 197 patients who underwent PV stenting between November 2016 and August 2019 were established as the stent group, whereas 29 patients with PV stenosis who were treated conservatively between July 2013 and October 2016 constituted the no-stent group. OS was compared between the two groups before and after propensity score matching (PSM). Risk factors associated with OS were evaluated using the Cox proportional hazards model. Procedure-associated adverse events were also evaluated. Results The stent group finally included 100 patients (median age, 65 [interquartile range, 58–71] years; 64 male). The no-stent group included 22 patients (69 [61–75] years, 13 male). Stent placement was successful in 95% of attempted cases, and the 1- and 2-year stent occlusion–free survival rate was 56% (95% confidence interval, 45%–69%) and 44% (32%–60%), respectively. The median stent occlusion–free survival time was 176 (interquartile range, 70–440) days. OS was significantly longer in the stent group than in the no-stent group (median 294 vs. 87 days, p < 0.001 before PSM, p = 0.011 after PSM). The 1- and 3-year OS rates before PSM were 40% and 11%, respectively, in the stent group. The 1-year OS rate after PSM was 32% and 5% in the stent and no-stent groups, respectively. Anemia requiring transfusion (n = 2) and acute thrombosis necessitating re-stenting (n = 1) occurred in three patients in the stent group within 1 week. Conclusion Percutaneous placement of a PV stent may be effective in improving OS in patients with malignant PV stenosis.

show abstract

“…Anticoagulation regimen was determined based upon the patient’s history of atrial fibrillation, rather than maintenance of splenic stent patency and likely would have consisted of a less aggressive regimen in the absence of this history. There are no standardized guidelines regarding anticoagulation after portomesenteric stenting, and some studies have failed to find an association between type of anticoagulation and risk of stent thrombosis (Sheth et al 2018 ). At 6 months follow-up, the patient remained free of abdominal ascites.…”

Section: Discussionmentioning

confidence: 99%

Splenic vein stenting for recurrent chylous ascites in sinistral portal hypertension: a case report

2021

View full text Add to dashboard Cite

Background Sinistral portal hypertension results from obstruction or stenosis of the splenic vein and is characterized by normal portal vein pressures and liver function tests. Gastrointestinal bleeding is the most common presentation and indication for treatment. Although sinistral portal hypertension-related chylous ascites is rare, several cases have described successful treatment with portal venous, rather than splenic venous, recanalization. Splenectomy is effective in the treatment of sinistral portal hypertension-related bleeding, although recent studies have evaluated splenic vein stenting and splenic arterial embolization as minimally-invasive treatment alternatives. Splenic vein stenting may be a viable option for other presentations of sinistral portal hypertension. Case presentation A 59-year-old gentleman with a history of necrotizing gallstone pancreatitis was referred to interventional radiology for management of recurrent chylous ascites. Analysis of ascites demonstrated a triglyceride level of 1294 mg/dL. Computed tomography revealed splenic and superior mesenteric venous stricture. The patient elected to undergo minimally invasive transhepatic portal venography, which confirmed the presence of splenic vein and superior mesenteric vein stenosis. Venography of the splenic vein showed reversal of portal venous flow, multiple collaterals, and a pressure gradient of 14 mmHg. Two 10 mm × 40 mm Cordis stents were placed, which decreased the pressure gradient to 7 mmHg and resolved the portosystemic collaterals. At 6 months follow-up, the patient had no recurrent episodes of ascites. Conclusion The current case highlights the successful treatment of sinistral portal hypertension-related intractable chylous ascites treated with transhepatic splenic vein stenting. Splenic venous stent patency rates of 92.9% at 12 months have been reported. Rebleeding rates of 7.1% for splenic vein stenting, 16% for splenectomy, and 47.8% for splenic arterial embolization have been reported in the treatment of sinistral portal hypertension-related gastrointestinal bleeding. The literature regarding splenic vein stenting for sinistral portal hypertension-related ascites is less robust. Technical and clinical success in the current case suggests that splenic vein recanalization may be a safe and viable option in other sinistral portal hypertension-related symptomatology. Level of Evidence: Level 4, Case Report.

show abstract

Portomesenteric Venous Stenting for Palliation of Ascites and Variceal Bleeding Caused by Prehepatic Portal Hypertension

Cited by 9 publications

References 20 publications

Portomesenteric Venous Complications after Pancreatic Surgery with Venous Reconstruction: Imaging and Intervention

Portomesenteric Venous Complications after Pancreatic Surgery with Venous Reconstruction: Imaging and Intervention

Effect of Stent Placement on Survival in Patients with Malignant Portal Vein Stenosis: A Propensity Score–Matched Study

Splenic vein stenting for recurrent chylous ascites in sinistral portal hypertension: a case report

Contact Info

Product

Resources

About