Percutaneous Transhepatic Portal Vein Angioplasty and Stent Placement after Liver Transplantation: Early Experience
ABSTRACT In four patients who underwent liver transplantation, portal vein thrombosis was associated with esophageal varices and significant gastrointestinal bleeding. In a fifth liver transplant patient, portal vein stenosis was suspected when evidence of hepatic ischemia was revealed at liver biopsy. Four patients were treated with percutaneous transhepatic portal vein angioplasty. Percutaneous recanalization was precluded by technical factors in the remaining patient. Early in the series, one patient required surgical excision of what proved to be a thick cuff of fibrous tissue and lymph nodes after angioplasty failed to widen the stenosis significantly. Later, a patient with residual stenosis was treated successfully by means of intravascular stent placement. Of the four patients treated, three eventually died secondary to multiple problems unrelated to the percutaneous procedure. This early experience suggests that transhepatic portal vein interventions are feasible in patients who have received liver transplants and may prove useful at least in the early postprocedure period.
Article: Percutaneous transhepatic portography for the treatment of early portal vein thrombosis after surgery.[show abstract] [hide abstract]
ABSTRACT: We treated three cases of early portal vein thrombosis (PVT) by minimally invasive percutaneous transhepatic portography. All patients developed PVT within 30 days of major hepatic surgery (one case each of orthotopic liver transplantation, splenectomy in a previous liver transplant recipient, and right extended hepatectomy with resection and reconstruction of the left branch of the portal vein for tumor infiltration). In all cases minimally invasive percutaneous transhepatic portography was adopted to treat this complication by mechanical fragmentation and pharmacological lysis of the thrombus. A vascular stent was also positioned in the two cases in which the thrombosis was related to a surgical technical problem. Mechanical fragmentation of the thrombus with contemporaneous local urokinase administration resulted in complete removal of the clot and allowed restoration of normal blood flow to the liver after a median follow-up of 37 months. PVT is an uncommon but severe complication after major surgery or liver transplantation. Surgical thrombectomy, with or without reconstruction of the portal vein, and retransplantation are characterized by important surgical morbidity and mortality. Based on our experience, minimally invasive percutaneous transhepatic portography should be considered an option toward successful recanalization of early PVT after major liver surgery including transplantation. Balloon dilatation and placement of a vascular stent could help to decrease the risk of recurrent thrombosis when a defective surgical technique is the reason for the thrombosis.CardioVascular and Interventional Radiology 30(6):1222-6. · 2.09 Impact Factor
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ABSTRACT: Diagnostic imaging and interventional radiology play key roles in the evaluation and management of patients who are being evaluated for potential liver transplantation (LTX) and of those who have received a transplanted liver. Technical advances in imaging equipment and technique allow more accurate assessment and often obviate unnecessary or nontherapeutic surgery or invasive techniques such as catheter angiography.Liver Transplantation 03/2006; 12(2):184-93. · 3.39 Impact Factor
Article: Percutaneous thrombolysis and stent placement for the treatment of portal vein thrombosis after liver transplantation: long-term follow-up.[show abstract] [hide abstract]
ABSTRACT: The durable use of percutaneous minimally invasive techniques for the treatment of portal venous thrombosis after liver transplant has not been widely described. This report illustrates two cases in which percutaneous thrombolysis, angioplasty, and endovascular stent placement were successfully used to treat portal vein thrombosis in patients with recent liver transplants. Liver dysfunction was initially manifested by the elevation of liver enzymes or the development of marked ascites and confirmed in both cases by sonography and angiography. The occluded portal vein was accessed by either a transjugular transhepatic puncture or direct transhepatic catheterization. Intraportal thrombolytic infusion, angioplasty, and stent placement were accomplished without complication. At the most recent follow-up, portal vein patency had been maintained for 2.5 and 4.5 years. These results demonstrate the technical feasibility and long-term patency of angioplasty and endovascular stent placement for the treatment of portal vein thrombosis in liver transplant recipients.Transplantation 05/1998; 65(8):1124-6. · 4.00 Impact Factor