Use of drug-coated balloons in the management of a recalcitrant postsurgical hepatic vein stenosis in a pediatric patient

Abstract

Drug-coated balloons (DCB) are a treatment alternative to conventional angioplasty in arterial, hemodialysis fistulas, and venous stenoses. This case report describes a child with the diagnosis of hepatoblastoma treated with chemotherapy and a right extended hepatectomy with venous reconstruction. The patient presented with signs and symptoms of portal hypertension due to a hepatic venous outflow obstruction secondary to stenosis of the surgical anastomosis. The response to conventional angioplasty was limited with frequent recurrence of symptoms. DCBs were used as an alternative prior to stent consideration aiming to assess if these devices could provide improvement of the symptoms and as a long-term therapy. The use of DCBs increased the time interval of reinterventions in comparison with conventional angioplasty. The patient eventually required stents due to recurrence of the primary disease. While this report does not provide an in-depth evaluation in terms of the efficacy and safety of DCB, this case illustrates a potential novel treatment modality to be considered for children, when stenotic venous lesions not amenable for stenting are present.

Case Report: Interventional therapy for coronary artery occlusion in a 6-year-old child with Kawasaki disease

“…In 2022, Zheng et al reported another case about an 18-year-old girl who had severe stenosis in the proximal RCA sequelae with KD was treated with DCB and had an excellent result at one-year follow-up (10). Previously, limited case reports about paclitaxel-coated balloon treatment for renal artery, hepatic vein, and pulmonary artery stenosis in children had been published (11)(12)(13). To date, no severe adverse effects of the paclitaxel-coated balloon have been found in children.…”

Liver Interventions in Children

“…12,15 The use of drug-coated balloons of PV stenosis in children has also been described. 13 Hepatic Vein and Inferior Vena Cava Obstruction Hepatic vein and inferior vena cava (IVC) complications are less frequent than other vascular complications, occurring in less than 1.5% of cases, and are more common in the pediatric population and after a redo transplant. They can be acute or chronic and lead to thrombosis or stenosis, frequently occurring at the site of the surgical anastomosis.…”

“…The use of drug-coated balloons has been described for the treatment of portal vein stenosis in children. 13 Stents might be needed in case of a poor result after PTA or complication (e.g., dissection, rupture). Small patients have a higher incidence of spasm in response to mechanical stimulus and having nitroglycerin or other vasodilators available is recommended.…”