Long‐term results of the percutaneous transhepatic venoplasty of portal vein stenoses after pediatric liver transplantation

Abstract

This paper has the objective to evaluate retrospectively the long-term results of transhepatic treatment of PV stenoses after pediatric LT. During an eight-yr period, 15 children with PV stenoses underwent PTA with balloon dilation or stent placement in case of PTA failure after LT. Patients' body weights ranged from 9.3 to 46kg (mean, 15.5kg). PV patency was evaluated in the balloon dilation and in the stent placement groups. Technical and clinical successes were achieved in all cases with no complication. Eleven patients (11/15; 73.3%) were successfully treated by single balloon dilation. Four patients (4/15; 26.7%) needed stent placement. One patient was submitted to stent placement during the same procedure because of PTA failure. The other three developed clinical signs of portal hypertension because of PV restenoses two, eight, and twenty-eight months after the first PTA. They had to be submitted to a new procedure with stent placement. The follow-up time ranged from 3 to 8.1 yr (mean, 6.3 yr). In conclusion, transhepatic treatment of PV stenoses after pediatric LT with balloon dilation or stent placement demonstrated to be a safe and effective treatment that results in long-term patency.

Gelfoam for Closure of Large Percutaneous Transhepatic and Transsplenic Puncture Tracts in Pediatric Patients

“…Carnevale et al performed autologous clot tract embolization by filling the sheath with the patient's blood, pulling it back to the parenchymal tract and leaving it in place for at least 10 -15 minutes for hemostasis. Compression was additionally performed for 15 minutes [10]. Reports concerning transsplenic accesses of more than 5-F in children are anecdotal and coils were used for closure of these puncture tracts [11].…”

Correction of extrahepatic portal hypertension in pediatric patient after liver transplantation

“…По данным мировой лите ратуры, портальный стеноз не является казуисти ческим осложнением после трансплантации печени от родственных доноров [2][3][4][5][6]. В педиатрической практике стеноз воротной вены составляет до 7% у всех детей, перенесших трансплантацию печени, а согласно отдельным источникам, может достигать 27% в определенных группах реципиентов [7][8][9][10][11][12]. При этом тромбоз воротной вены может являться причиной потери трансплантата и сопряжен с высо ким уровнем летальности [13].…”

“…Клинически стеноз воротной вены проявляется синдромом портальной гипертензии (спленомега лия, асцит, панцитопения, варикозно расширенные вены пищевода, желудочнокишечные кровотече ния) [12].…”

“…Одним из наиболее эффектив ных и малоинвазивных методов лечения является эндоваскулярная ангиопластика, в том числе чрес кожное чреспеченочное стентирование воротной вены [12,[19][20][21].…”

Percutaneous segmental dilatation of portal stenosis after paediatric liver transplantation to avoid or postpone surgery: two cases and literature review

“…Patency of the vascular reconstructions is a key factor in the success of LT [3], and complications of the portal anastomotic stenosis may cause the failure of surgery [4]. The disproportion in vessel calibre between adult donor and recipient, tension and torsion of the anastomosis (sometimes treated with surgical patches) are the main causes of early or late portal stenosis [3].…”