Portal vein stent placement after hepatobiliary and pancreatic surgery

Abstract

Purpose To evaluate the long-term outcomes of percutaneous transhepatic stent placement for portal vein (PV) stenosis after liver transplantation (LT) and hepato-pancreato-biliary (HPB) surgery. Methods Retrospective study of 455 patients who underwent LT and 522 patients who underwent resection of the pancreatic head between June 2011 and February 2016. Technical success, clinical success, patency, and complications were evaluated for both groups. Results A total of 23 patients were confirmed to have postoperative PV stenosis and were treated with percutaneous transhepatic PV stent placement. The technical success rate was 100%, the clinical success rate was 80%, and the long-term stent patency was 91.3% for the entire study population. Two procedure-related hemorrhages and two early stent thromboses occurred in the HPB group while no complications occurred in the LT group. A literature review of selected studies reporting PV stent placement for the treatment of PV stenosis after HPB surgery and LT showed a technical success rate of 78-100%, a clinical success rate of 72-100%, and a long-term patency of 57-100%, whereas the procedure-related complication rate varied from 0-33.3%. Conclusions Percutaneous transhepatic PV stent is a safe and effective treatment for postoperative PV stenosis/occlusion in patients undergoing LT regardless of symptoms. Due to increased risk of complications, the indication for percutaneous PV stent placement after HPB surgery should be limited to patients with clinical symptoms after an individual assessment.

Effect of Stent Placement on Survival in Patients with Malignant Portal Vein Stenosis: A Propensity Score–Matched Study

“…However, placement of a PV stent is not generally applied, most likely owing to a lack of sufficient evidence demonstrating its benefits to survival and because of its technical difficulties. A few investigators have reported on the usefulness of PV stent placement; however, these studies had a sample size of < 40 patients and used a single-arm methodology [ 8 15 16 17 18 19 ].…”

Gastroduodenal artery pseudoaneurysm and chronic superior mesenteric vein thrombosis treated with transcatheter embolization and stent dilatation, respectively: 7 year clinical and imaging follow-up

“…Additionally, a recent literature review by Khan et al suggests that portal vein stent placement following hepatobiliary and pancreatic surgery is a safe and effective treatment in patients with portal vein stenosis, with clinical success rates of 72%-100%, long-term patency of 57%-100%, and procedure-related complication rates of 0%-33.3% [12] . While this literature review included a heterogeneous population of post-surgical and liver transplant patients, we believe the technical success rates and complication rates are relatively generalizable.…”

“…Furthermore, the role of long-term anticoagulation following splanchnic vein stent dilation is not well understood. Studies have varied in their usage of anticoagulation with bleeding risk and the risk of stent thrombus formation factoring into this decision [12] . Interestingly, our patient developed partial occlusion of the SMV stent 1 week following the procedure at which time anticoagulation was resumed and the patient's symptoms quickly improved.…”

“…Anticoagulation is the recommended first-line treatment in hemodynamically stable patients with symptomatic superior splanchnic vein thrombosis [ 8 , 9 ]. While less commonly performed, percutaneous stent dilatation has demonstrated efficacy in relieving portal hypertension while also providing symptom relief in patients with stenosis or occlusion of splanchnic veins and can serve as a definitive treatment in patients unresponsive to anticoagulation, or where anticoagulation is contraindicated [10] , [11] , [12] .…”

Graft type for superior mesenteric and portal vein reconstruction in pancreatic surgery – A systematic review

“…However, the therapeutic consequence of detecting an asymptomatic SMV-PV stenosis/occlusion is under debate. Due to increased risk of complications, the indication for percutaneous PV stent placement after pancreatectomy with venous resection and reconstruction is recommended to be limited to patients with clinical symptoms [42,43] . Most patients are asymptomatic, whereas others present with the typical clinical signs of portal hypertension, including gastrointestinal hemorrhage, ascites and splenomegaly [42] .…”