Endovascular Recanalization of Symptomatic Portomesenteric Venous Obstruction after Pancreaticoduodenectomy and Radiation

Hoffer, Eric K.; Krohmer, Steven; Gemery, John M.; Zaki, Bassem I.; Pipas, J. Marc

doi:10.1016/j.jvir.2009.09.001

Cited by 16 publications

(19 citation statements)

References 17 publications

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“…Stenosis can be caused by inflammation of the structures surrounding the portal vein or can result from surgical injury and post-surgical adhesion to the portal vein [4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…The results of many studies on percutaneous transhepatic portal vein stent placement suggest that the procedure is safe and has few major complications [1,3,6,8,23,27].…”

Section: Discussionmentioning

confidence: 99%

“…Some investigators have performed anticoagulant therapy during and after stent placement to prevent it [1,3,6,9,15,19,20]. On the other side, anticoagulation can be responsible for bleeding along the percutaneous transhepatic route, hypersensitivity, and heparininduced thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

“…Portal hypertension subsequent to pancreatoduodenectomy (PD) is likely to be linked to extra-hepatic portal vein (PV) stenosis, and it can occur after its concurrent resection and anastomosis, pre-or intra-operative radiotherapy or local recurrence around the portal vein [1][2][3][4]. The incidence rate for portal vein stenosis is reported to be 11% to 23% [5,6], but the incidence of refractory ascites is unknown. Portal hypertension without hepatic dysfunction secondary to PV stenosis causes gastrointestinal bleeding from gastroesophageal or jejunal varices and refractory ascites [7].…”

Section: Introductionmentioning

confidence: 99%

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Refractory Ascites after Pancreato-Duodenectomy - Time to Rethink an Old Dogma

Meillat¹,

Ewald²,

Piana³

et al. 2017

J Clin Case Rep

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A rare case of refractory ascites caused by benign portal vein stenosis after pancreatoduodenectomy (PD) is reported. A dogma claims that ascites is found in portal hypertension with an intrahepatic block only. However, in the postoperative state, the pathophysiologic condition is altered, which made diagnosis difficult.A 69-year-old man who had undergone PD for lower bile duct carcinoma in situ, developed in postoperative course a pseudoaneurysm of the common hepatic artery successfully treated by stent graft. Six months later, the patient developed refractory ascites. CT scan revealed a severe stricture in the main trunk of the portal vein, probably due to extrinsic compression by the stent in the hepatic artery. Percutaneous transhepatic portography was performed and stent-graft was placed over the stenotic segment. Portal blood flow was corrected immediately. One week after the stenting procedure the patient was free of ascites and control physical and biochemical examination three years later is completely normal.

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“…Stenosis can be caused by inflammation of the structures surrounding the portal vein or can result from surgical injury and post-surgical adhesion to the portal vein [4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…The results of many studies on percutaneous transhepatic portal vein stent placement suggest that the procedure is safe and has few major complications [1,3,6,8,23,27].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Refractory Ascites after Pancreato-Duodenectomy - Time to Rethink an Old Dogma

Meillat¹,

Ewald²,

Piana³

et al. 2017

J Clin Case Rep

View full text Add to dashboard Cite

show abstract

“…Portal vein (PV) stenosis or obstruction can be caused by tumor invasion [1], radiotherapy [2] [3], and surgical procedures such as liver transplantation or PV resection during pancreatic resection [4] [5]. After lymph node dissection within the hepatoduodenal ligament for a pancreatobiliary neoplasm, the PV is directly exposed in the region around the pancreatic or biliary anastomosis; therefore, it is considered that it is affected by the conditions in this area.…”

Section: Introductionmentioning

confidence: 99%

Portal Vein Stenosis Caused by Postoperative Complications after Pancreatobiliary Surgery

Kinoshita¹,

Tsubakihara²,

Yamazoe³

et al. 2017

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Background: Portal vein (PV) stenosis or obstruction is sometimes observed in patients who were performed pancreatobiliary surgery. These conditions such as pancreatic fistulas (PF) and intra-abdominal infections after pancreatobiliary surgery still represent significant clinical issues. In addition, insufficient attention is paid to the fact that severe stenosis of the PV can result in life-threatening complications. Material and Methods: At our institution, lymph node dissection within the hepatoduodenal ligament was performed for biliary or pancreatic neoplasms in 68 patients between October 2005 and April 2017. The diameter of the PV was measured on computed tomography scans obtained before and after the operation. PV stenosis was defined as a >50% reduction in the diameter of the PV. The degree of PF (Pancreatic Fistula) was defined by the International Study Group of Pancreatic Fistula after pancreaticoduodenectomy. Furthermore, the Clavien-Dindo (CD) classification was used to assess the complications that occurred in cases in which pancreatojejunostomy was not performed. The relationship between the degree of PV stenosis and the occurrence of postoperative complications was analyzed. Results: The overall frequency of PF was 56.3% (18 patients). Grade B or C PF occurred in 5 patients (15.6%). In the present small series, a correlation was detected between the degree of PV stenosis and the occurrence of postoperative complications after pancreatobiliary surgery (p < 0.05). Conclusions: Clinicians should keep in mind that the PV can narrow in cases in which grade B or C PF or intra-abdominal abscesses occur after pancreatobiliary surgery.

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Venous Diseases in Malignancy

Ram

Kuban

2018

Cancer and Cardiovascular Disease

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Endovascular Recanalization of Symptomatic Portomesenteric Venous Obstruction after Pancreaticoduodenectomy and Radiation

Cited by 16 publications

References 17 publications

Refractory Ascites after Pancreato-Duodenectomy - Time to Rethink an Old Dogma

Refractory Ascites after Pancreato-Duodenectomy - Time to Rethink an Old Dogma

Portal Vein Stenosis Caused by Postoperative Complications after Pancreatobiliary Surgery

Venous Diseases in Malignancy

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