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

Funaki, Brian; Rosenblum, Jordan D.; Leef, Jeffrey A.; Hackworth, C A; Szymski, George X.; Alonso, Estella M.; Piper, James; Whitington, Peter F.

doi:10.2214/ajr.165.1.7785578

Cited by 67 publications

(58 citation statements)

References 5 publications

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“…Confirmation and therapeutic intervention for all venous stenoses are done by invasive angiography, thus making interventional radiology essential. 17,18 However, in our experience the presence of symptoms in conjunction with angiographic evidence of major retroperitoneal collaterals may be more indicative of a clinically significant stenosis than a measurable angiographic gradient. 18 Thus, a majority of portal vein and hepatic vein lesions have been managed by balloon angiography and metallic stenting for recurrent lesions.…”

Section: Discussionmentioning

confidence: 61%

Long-Term Venous Complications After Full-Size and Segmental Pediatric Liver Transplantation

Buell¹,

Funaki²,

Cronin³

et al. 2002

Annals of Surgery

254

207

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ObjectiveTo assess the long-term incidence of venous complications, including portal vein and hepatic vein stenoses, in both whole cadaveric and reduced-size cadaveric and living related liver transplants in a pediatric population, and to assess the therapeutic modalities in the treatment of these lesions. Summary Background DataA shortage in appropriate-sized liver grafts for pediatric patients led to the use of segmental liver grafts, which became the predominant graft used in 325 of 600 (54%) transplants at the authors' institution. To assess the long-term impact of this strategy, the authors examined the incidence of late (Ͼ90 days) venous complications and the efficacy of all therapeutic interventions. MethodsSix hundred pediatric liver transplants were performed in 325 patients, with reduced-size or split (RSS; n ϭ 207), living related (LRD; n ϭ 118), or full-size cadaveric grafts (FS; n ϭ 275) from 1988 to 2000. All transplants identified with late portal vein or vena caval stenoses or thromboses from a cohort of 524 grafts with survival greater than 90 days were reviewed for demographics, symptoms, therapeutic intervention, recurrence, morbidity, and mortality. ResultsFifty lesions were identified in 49 patients (38 portal vein and 12 hepatic vein-cava stenoses). Sex distribution was similar between portal vein and hepatic vein to cava, as was the mean patient age. Portal vein stenoses occurred in 32 LRD, 3 RSS, and 3 FS, while hepatic vein-cava stenoses occurred in 2 LRD, 8 RSS, and 2 FS. In the 38 portal vein stenoses, 9 had prior perioperative portal vein and/or 5 hepatic artery thrombectomies. Portal vein stenoses were identified after bleeding (17/38), ascites (6/38), increased liver function tests (6/38), splenomegaly (5/38), or screening ultrasound (4/38). Portal vein stenosis was associated most often with cryopreserved vein for portal conduits. Excluding conduits, the incidence of late portal vein complications was reduced to 1%. Lesions became symptomatic at a mean of 50.8 Ϯ 184.2 months posttransplant. All patients underwent venous angioplasty with a 66% (25/38) success rate, while 7 of 25 required further angioplasty and stenting. In the 13 unsuccessful angioplasties, 8 required surgical shunts for complete portal vein thrombosis. Recurrence occurred in 9 patients: all were amenable to stenting. Nine patients (24%) eventually died of sepsis (4) and surgical deaths at shunt or retransplant (5). Hepatic vein-cava stenoses occurred after a mean of 37.2 Ϯ 35.2 months, presenting with ascites (n ϭ 10), increased liver function tests (n ϭ 2), and splenomegaly (n ϭ 2). All patients were diagnosed by venogram and managed by balloon dilatation alone (n ϭ 6) or stented (n ϭ 4), with an 80% (10/12) success, with two late recurrences amenable to repeat angioplasty or stenting. Long-term survival was 80% at 1 year. ConclusionsThe use of segmental grafts without venous conduits is not associated with a significant rate of long-term venous complication. When late venous complications do occur, venous angiop...

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Section: Discussionmentioning

confidence: 61%

Long-Term Venous Complications After Full-Size and Segmental Pediatric Liver Transplantation

Buell¹,

Funaki²,

Cronin³

et al. 2002

Annals of Surgery

254

207

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“…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].…”

Section: Portal Complicationsmentioning

confidence: 99%

Interventional radiology in the management of complications after liver transplantation

et al. 2004

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The arrival of new surgical transplantation techniques, such as split living donor or auxiliary liver transplantation, have increased the incidence of vascular and biliary complications. The causes, symptoms, and diagnostic modalities of arterial, portal caval, and biliary complications are detailed. Interventional techniques, such as balloon angioplasty and stent placement in the arterial and portal tree, as well as biliary interventional techniques, are discussed.

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“…Since the first report of percutaneous portal venoplasty in children by Raby et al [7], it has been widely accepted as a treatment of choice for the management of venous stenosis complicating liver transplantation [12,13,16,[20][21][22]. The reported initial technical success rate was between 76 and 100% [8,16,22].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2007

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Portal venous stenosis is relatively a rare complication after liver transplantation in children and it sometimes leads to life threatening event due to gastrointestinal bleeding or graft failure. Recently, balloon dilatation has been widely accepted as a treatment of choice for the management of portal venous stenosis. The purpose of this study was to evaluate the feasibility of transileocolic venous balloon dilatation for the management of primary and recurrent portal venous stenosis after living donor liver transplantation (LDLT) in children. The records of 57 pediatric liver transplants were retrospectively reviewed. Nine patients (15.8%) with portal venous stenosis were identified. Seven symptomatic children with portal venous stenosis underwent balloon dilatation. Two approaches were employed for balloon dilatation; the transileocolic venous approach and the percutaneous transhepatic approach. In patients with recurrent stenosis, careful follow-up was carried out while they were asymptomatic. Twelve balloon dilatations were performed in seven children with primary or recurrent portal venous stenoses. The initial technical success rate was 91.7% (11/12), while 6 out of 12 (50.0%) procedures resulted in recurrent stenosis. Five out of six recurrent stenoses required repeated balloon dilatation. The clinical success rate of balloon dilatation in our study was 85.7% (6/7). Other than recurrent stenosis, two procedure-related complications occurred. In conclusion, transileocolic venous balloon dilatation was a safe and effective procedure for portal venous stenosis after LDLT in children.

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

Cited by 67 publications

References 5 publications

Long-Term Venous Complications After Full-Size and Segmental Pediatric Liver Transplantation

Long-Term Venous Complications After Full-Size and Segmental Pediatric Liver Transplantation

Interventional radiology in the management of complications after liver transplantation

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

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