Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2016; 22(44): 9822-9828
Published online Nov 28, 2016. doi: 10.3748/wjg.v22.i44.9822
Therapeutic efficacy and stent patency of transhepatic portal vein stenting after surgery
Ung Bae Jeon, Chang Won Kim, Tae Un Kim, Ki Seok Choo, Joo Yeon Jang, Kyung Jin Nam, Chong Woo Chu, Je Ho Ryu
Ung Bae Jeon, Tae Un Kim, Ki Seok Choo, Joo Yeon Jang, Kyung Jin Nam, Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Gyeongnam 626-770, South Korea
Chang Won Kim, Department of Radiology, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Hospital, Pusan 602-739, South Korea
Chong Woo Chu, Je Ho Ryu, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Gyeongnam 626-770, South Korea
Author contributions: Kim CW designed the study; Jeon UB analyzed the data and wrote the paper; Kim TU performed the data analysis; Choo KS, Jang JY and Nam KJ collected the data; Chu CW and Ryu JH designed the study, and revised the paper; all authors have read and approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by the Pusan National University Yangsan Hospital Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interest related to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chang Won Kim, MD, Department of Radiology, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Hospital, 10, 1-Ga, Ami-Dong, Seo-Gu, Pusan 602-739, South Korea. radkim@nate.com
Telephone: +82-51-2407354 Fax: +82-51-2447354
Received: September 9, 2016
Peer-review started: September 10, 2016
First decision: September 28, 2016
Revised: October 6, 2016
Accepted: October 30, 2016
Article in press: October 31, 2016
Published online: November 28, 2016
Abstract
AIM

To evaluate portal vein (PV) stenosis and stent patency after hepatobiliary and pancreatic surgery, using abdominal computed tomography (CT).

METHODS

Percutaneous portal venous stenting was attempted in 22 patients with significant PV stenosis (> 50%) - after hepatobiliary or pancreatic surgery - diagnosed by abdominal CT. Stents were placed in various stenotic lesions after percutaneous transhepatic portography. Pressure gradient across the stenotic segment was measured in 14 patients. Stents were placed when the pressure gradient across the stenotic segment was > 5 mmHg or PV stenosis was > 50%, as observed on transhepatic portography. Patients underwent follow-up abdominal CT and technical and clinical success, complications, and stent patency were evaluated.

RESULTS

Stent placement was successful in 21 patients (technical success rate: 95.5%). Stents were positioned through the main PV and superior mesenteric vein (n = 13), main PV (n = 2), right and main PV (n = 1), left and main PV (n = 4), or main PV and splenic vein (n = 1). Patients showed no complications after stent placement. The time between procedure and final follow-up CT was 41-761 d (mean: 374.5 d). Twenty stents remained patent during the entire follow-up. Stent obstruction - caused by invasion of the PV stent by a recurrent tumor - was observed in 1 patient in a follow-up CT performed after 155 d after the procedure. The cumulative stent patency rate was 95.7%. Small in-stent low-density areas were found in 11 (55%) patients; however, during successive follow-up CT, the extent of these areas had decreased.

CONCLUSION

Percutaneous transhepatic stent placement can be safe and effective in cases of PV stenosis after hepatobiliary and pancreatic surgery. Stents show excellent patency in follow-up abdominal CT, despite development of small in-stent low-density areas.

Keywords: Liver, Vein, Stent, Computed tomography, Surveillance, Efficace

Core tip: Portal vein (PV) stenosis can occur after hepatobiliary and pancreatic surgery. Portal hypertension due to PV stenosis induces clinical manifestations in many organs, including intractable ascites, esophageal and gastrointestinal bleeding, and liver dysfunction. Percutaneous transhepatic stent placement can be safe and effective in cases of PV stenosis since stents show excellent patency on follow-up abdominal computed tomography despite the presence of small in-stent low-density areas.