Portal vein stenosis complicating liver transplantation in children: percutaneous transhepatic angioplasty.

Abstract

Portal vein stenosis complicating orthotopic liver transplantation in children is uncommon. The authors report their early experience with transhepatic portal vein angioplasty in the treatment of portal vein stenosis in this setting. The technique was used in two children (aged 2 and 6 years) who had undergone liver transplantation for biliary atresia 15 and 42 months earlier, respectively. Both patients presented with chronic anemia and intermittent gastrointestinal bleeding. The diagnosis of portal vein stenosis was confirmed at fine-needle splenoportography. Access to the portal venous system was gained by means of a transhepatic approach. Low-profile angioplasty balloon catheters were used to dilate anastomotic strictures of the portal vein in both children. At the end of the procedure, the tract within the liver was occluded with gelatin sponge pledgets. Both procedures were technically successful and caused no complications, and in both patients gastrointestinal bleeding ceased.

Interventional radiology in the management of complications after liver transplantation

“…The portal vein anastomosis is technically challeng- 34,35,36,37,38]. The method consists of a percutaneous approach of a portal branch in the liver, whereas transjugular approach has been reported by some authors [39].…”

Portal vein stenosis in children with segmental liver transplants: treatment with percutaneous transhepatic venoplasty.

“…Successful percutaneous portal venoplasty in two children was first reported by Raby et al [4]. Rollins et al [5] later described their early experience with two children, one of whom received a left-lateral-segment liver transplant from an adult donor. Recently, Zajko et al [6] reported results for four children with follow-up between 9 and 30 months.…”

Transileocolic venous balloon dilatation for the management of primary and recurrent portal venous stenosis after living donor liver transplantation in children

“…Some authors described that differences in portal venous diameters between donor and recipient, malrotation of the vessels or kinking of the portal vein may cause portal venous stenosis after liver transplantation [13,14]. In general, its consequences are not so catastrophic as arterial and biliary complications, however, some authors reported it could be a cause of graft failure [6,15,16] and mortality due to life threatening variceal bleeding [17].…”