Therapeutic efficacy and stent patency of transhepatic portal vein stenting after surgery

Figure 1 A selection failure case. A 78-year-old man (patient No. 23) presenting with right PV stenosis after hepatic central segmentectomy with liver metastasis from colon cancer. A: Axial CT scan 40 d after surgery showing severe stenosis (arrow) at the right PV. B: Percutaneous transhepatic portogram showing peripheral right PV. Main PV was not selected due to severe stenosis at the right PV. CT: Computed tomography; PV: Portal vein.

Figure 2 Kaplan-Meier results for cumulative patency rates among 22 patients who underwent portal vein stenting. Initial decrease in patency rate occurred within 155 d after procedure. Further decrease in patency rate was not observed during the entire follow-up period. The cumulative patency rate for PV stent was 95.7%. PV: Portal vein.

Figure 3 A 68-year-old woman (patient No. 8) presenting with main portal vein stenosis after pylorus-preserving pancreatoduodenectomy for duodenal gastrointestinal stromal tumor. She presented with anorexia and increased JP drain output during the follow-up period. A: Axial CT image 13 d after surgery showing stenosis at junction between the PV and SMV (arrowheads); B: Curved planar reformatted (CPR) image from abdominal CT 13 d after surgery showing stenosis at junction between the PV and SMV (arrow); C: Percutaneous transhepatic portogram showing severe stenosis (> 50%) at the PV-SMV junction. The pressure gradient was not measured because of definite stagnation of the contrast medium. The contrast medium injected at the distal SMV is clearly stagnant; D: Portogram showing metallic stent in the main PV and SMV and the elimination of stenosis. After the procedure, the patient’s symptoms and signs improved; E: CPR image from abdominal CT 2 d after stenting showing patent stent with small in-stent low-density area (arrow); F: The extent of small in-stent low-density area decreased on CPR image from abdominal CT scan 555 d after stenting (arrow). CT: Computed tomography; PV: Portal vein; SMV: Superior mesenteric vein.