Surgical Access to Jejunal Veins for Local Thrombolysis and Stent Placement in Portal Vein Thrombosis

Schellhammer, F.; Esch, Jan Schulte Am; Hammerschlag, Sascha; Knoefel, Wolfram Trudo; Fürst, G.

doi:10.1007/s00270-007-9180-9

Cited by 7 publications

(2 citation statements)

References 15 publications

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“…Procedures PV stent placement has been described with a surgical approach via an ileal or jejunal vein [3,13,21,24,25] or a transjugular intrahepatic portosystemic shunt-type approach [4,11,18]. Nevertheless, as in our study, a transhepatic route has been most often used in the past with a very low rate of hemorrhagic complications [5, 6, 14-17, 20-22, 26].…”

Section: Discussionmentioning

confidence: 84%

Palliative Portal Vein Stent Placement in Malignant and Symptomatic Extrinsic Portal Vein Stenosis or Occlusion

Novellas

Denys

Bize

et al. 2008

Cardiovasc Intervent Radiol

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This article evaluates the results of portal vein (PV) stent placement in patients with malignant extrinsic lesions stenosing or obstructing the PV and causing symptomatic PV hypertension (PVHT). Fourteen patients with bile duct cancer (n = 7), pancreatic adenocarcinoma (n = 4), or another cancer (n = 3) underwent percutaneous transhepatic portal venous stent placement because of gastroesophageal or jejunal varices (n = 9), ascites (n = 7), and/or thrombocytopenia (n = 2). Concurrent tumoral obstruction of the main bile duct was treated via the transhepatic route in the same session in four patients. Changes in portal venous pressure, complications, stent patency, and survival were evaluated. Mean ± standard deviation (SD) gradient of portal venous pressure decreased significantly immediately after stent placement from 11.2 mmHg ± 4.6 to 1.1 mmHg ± 1.0 (P \ 0.00001). Three patients had minor complications, and one developed a liver abscess. During a mean ± SD follow-up of 134.4 ± 123.3 days, portal stents remained patent in 11 patients (78.6%); stent occlusion occurred in 3 patients, 2 of whom had undergone previous major hepatectomy. After stent placement, PVHT symptoms were relieved in four (57.1%) of seven patients who died (mean survival, 97 ± 71.2 days), and relieved in six (85.7%) of seven patients still alive at the end of follow-up (mean follow-up, 171.7 ± 153.5 days). Stent placement in the PV is feasible and relatively safe. It helped to relieve PVHT symptoms in a single session.

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