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

Abstract

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.

Long‐term outcome of primary percutaneous stent angioplasty for pediatric posttransplantation portal vein stenosis

“…This is in line with a recent systematic review of 243 pediatric patients: primary PTSA has higher technical success and lower restenosis rates (2.5% vs. 29.7%) compared with PTBA alone. [31] Notably, in our cohort, almost half of the patients (19/40) successfully received PTSA within 6 months after LT and 6 within 45 days after LT (PTSA n = 4; PTBA n = 2). PVS early after LT is often more elastic, and PTBA alone might be ineffective and more prone to a possible vessel tear at the anastomotic site.…”

“…[8,[10][11][12][13]30] However, most of these studies reported combined balloon and stent angioplasty data and PV diameters are often not reported. In a recently published systemic review of the literature, Sare et al [31] concluded that primary PTSA had technical success of 100%, which was significantly higher compared with balloon angioplasty. They clearly favored primary stent implantation as treatment of choice.…”

Imaging-guided interventions modulating portal venous flow: Evidence and controversies

“… 91 Primary stent placement was also shown to have a significantly higher success rate than balloon angioplasty (97–100% vs. 67–69%) in a recent meta-analysis. 92 …”

Interventional Radiology Options after Visceral Surgery

“…Although balloon angioplasty could be utilized in these patients, due to postsurgical fibrotic changes, re-stenosis and need for a second procedure is high. A recent systematic review of 393 patients who had interventional treatment due to portal vein stenosis after liver transplantation showed higher technical success and lower re-stenosis rates after primary stenting in relation to angioplasty alone [47].…”