Intervention Therapy for Portal Vein Stenosis/Occlusion After Pediatric Liver Transplantation

Gao, Haijun; Wang, Hao; Chen, Guang; Yi, Zhengjia

doi:10.12659/aot.902239

Cited by 15 publications

(33 citation statements)

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“…Percutaneous balloon dilatation with or without a stent TA was universally indicated for the diagnosis of PV stenosis in paediatric liver recipients as detected on Doppler ultrasound that was performed either for symptoms of portal hypertension or as routine follow‐up. The cut‐off diameter for the diagnosis of PV stenosis varied from an absolute value of less than 2.5‐3mm 16,19,25,28 to a reduction up to 50% 9,10,16,19,20,23,25,29 of the diameter of the PV anastomosis as compared to the extrahepatic PV on the mesenteric side, with flow acceleration at the stenotic segment up to 3–4 times that of the pre‐stenotic PV 7,16,19,27–29 . The presence of a post‐stenotic jet‐flow was included as a criterion by some 19,25–28 .…”

Section: Resultsmentioning

confidence: 99%

“…The symptom status of 56 cases was not reported 10,16,19,20,22,23,27,30 . Of the remaining, only 60 cases were reported separately as either asymptomatic ( n = 15) 6,9,28 or symptomatic ( n = 45), 6,7,9,13,21,24‐26,28,29 of whom 35 had hypersplenism and 13 had graft dysfunction (some patients had both).…”

Section: Resultsmentioning

confidence: 99%

“…The length of the stent should be able to cover a stenotic or occluded segment with minimal angulation between the PV and the proximal and distal edges of the deployed stent 11 and also be as short as possible to allow suitable length of unstented vessel in case re‐transplant becomes necessary 30 . Gao and colleagues report on the choice of balloon‐expanding stents for primary stent insertions and self‐expanding stents for recurrent stenosis 19 …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Percutaneous transhepatic interventional therapy of portal vein stenosis in paediatric liver transplantation: A systematic review of efficacy and safety

Kyaw

Lai

Iyer

et al. 2021

Pediatric Transplantation

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Purpose of the systematic review To determine the efficacy and safety of percutaneous trans‐hepatic balloon and/or stent angioplasty (PTA) in the management of portal vein (PV) stenosis following paediatric liver transplantation. Methods Articles were included from a systematic search of Medline, Embase, Cochrane CENTRAL, ClinicalTrials.gov and International Clinical Trials Registry from inception to the 29th of August 2020. Results There were 213 paediatric liver recipients who underwent PTA for PV stenosis in 19 included studies published between 1991 and 2019. Balloon angioplasty was the initial treatment in the majority (n = 153). Primary stent placement (n = 34) was performed for elastic recoil, intimal tears and PV kinks and rescue stent placement (n = 14) for recurrent PV stenosis following primary balloon angioplasty. The technical success was 97.6%–100% overall, 97.6%–100% for balloon‐angioplasty‐only and 100% for primary stenting. The clinical success was 50%–100% overall, 50%–100% for balloon‐angioplasty‐only and 100% for primary stenting. Long‐term PV patency was 50%–100% overall, 37.5%–100% for balloon‐angioplasty‐only and 100% for primary stenting. Primary balloon angioplasty was successful in 78% of the cases. Of the recurrent PV stenoses, 9% resolved with stent placement and one required a meso‐Rex shunt. There was one re‐transplantation without stenting. The complication rate was 2.6% for balloon‐angioplasty‐only (bleeding, liver abscess, 2 PV thromboses) and 5.9% for primary stenting (bleeding, stent‐fracture). There was no procedure‐related mortality. Conclusion Percutaneous transhepatic balloon angioplasty may be the initial management of portal vein stenosis in paediatric liver recipients. Stent placement may be a primary option in selected cases and a reliable rescue option for recurrent portal vein stenosis following balloon‐angioplasty‐only.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Percutaneous transhepatic interventional therapy of portal vein stenosis in paediatric liver transplantation: A systematic review of efficacy and safety

Kyaw

Lai

Iyer

et al. 2021

Pediatric Transplantation

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“…2B). 15,27,[31][32][33] No consensus exists regarding antiplatelet or anticoagulant therapy following stent placement. Several authors advocate for at least 6 months of oral anticoagulation and/or antiplatelet therapy following stent placement.…”

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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“…6 Since then, there have been numerous retrospective publications that have reported outcomes of this technique. 3,7 -15 The American Association for the Study of Liver Diseases (AASLD) and the American Society of Transplantation (AST) recommend the involvement of Interventional Radiologists to perform a diagnostic Doppler hepatic ultrasound and/or diagnostic angiogram to accurately locate the lesion, but do not provide a definitive management strategy for PVS in liver transplant patients. 16,17 The decision to perform endovascular treatment versus surgical shunting to correct the portal vein lesion largely remains a clinical decision based on provider preferences.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficacy of Endovascular Treatment of Portal Vein Stenosis in Liver Transplant Recipients: A Systematic Review

Sare

Chandra

Shanmugasundaram

et al. 2021

Vasc Endovascular Surg

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Purpose: To evaluate the efficacy of Angioplasty and Stent Placement for the treatment of Portal Vein Stenosis in Liver Transplant Recipients by performing a systematic review. Materials and Methods: The PubMed Database was extensively searched for articles describing Portal Vein Stenosis (PVS) as a complication in Liver Transplant (LT) patients. The initial database search yielded 488 unique records published in the PubMed Database, 19 of which were deemed to meet the inclusion criteria. Outcomes were separated into 2 groups (Group A included patients with primary angioplasty, Group B included patients with primary stent placement), and further subdivided into Adult and Pediatric populations. Results: Group A included a total of 282 LT patients with portal vein stenosis. The population was predominantly pediatric (n = 243). Group B included a total of 111 LT patients with portal vein stenosis. This population was predominantly adult (n = 66). Technical success was significantly higher in both Group B pediatric (100%) and adults (97%) compared to Group A (69.5%) and (66.7%) respectively. Re-stenosis rates were significantly lower in Group B pediatric group compared to Group A (2.3% vs 29.7%, χ2 = 13.9; p < 0.001). Overall major (3.1%) and minor complications rates (1.5%) were low. Conclusion: Primary stent placement appears to have higher technical success in both populations and lower re-stenosis rates for treatment of PVS in pediatric populations.

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Intervention Therapy for Portal Vein Stenosis/Occlusion After Pediatric Liver Transplantation

Cited by 15 publications

References 0 publications

Percutaneous transhepatic interventional therapy of portal vein stenosis in paediatric liver transplantation: A systematic review of efficacy and safety

Percutaneous transhepatic interventional therapy of portal vein stenosis in paediatric liver transplantation: A systematic review of efficacy and safety

Portal Venous Interventions after Liver Transplant

Safety and Efficacy of Endovascular Treatment of Portal Vein Stenosis in Liver Transplant Recipients: A Systematic Review

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