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Park JK, Han A, Hur S, Lee M, Jae HJ, Ahn S, Min S, Min SK. Long-Term Outcomes of Angioplasty and Stent Placement for Portomesenteric Vein Obstruction following Hepatobiliary and Pancreatic Surgery. J Vasc Interv Radiol 2025:S1051-0443(25)00281-7. [PMID: 40204182 DOI: 10.1016/j.jvir.2025.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 03/23/2025] [Accepted: 03/29/2025] [Indexed: 04/11/2025] Open
Abstract
PURPOSE To evaluate the long-term outcomes of endovascular treatment for postoperative portomesenteric vein (PMV) obstruction and identify prognostic factors influencing patency rates. MATERIALS AND METHODS This retrospective single-center study included patients who underwent endovascular intervention for PMV stenosis or occlusion after hepatobiliary and pancreatic surgery between January 2009 and December 2020. Patient characteristics, technical outcomes, and long-term patency rates were evaluated. In total, 116 patients underwent PMV intervention after liver transplantation (n = 66, 56.9%), hepatectomy (n = 21, 18.1%), or pancreatectomy (n = 29, 25%). Interventions included balloon angioplasty alone (n = 7, 6%) or stent placement (n = 106, 91.4%), performed at a median of 125 days (interquartile range, 8.5-436.5 days) after surgery. RESULTS The technical success rate of the PMV intervention was 95.7%. Patency rates varied significantly across the surgical groups, with liver transplantation showing superior outcomes compared with hepatectomy and pancreatectomy (5-year primary patency rates: 94.4%, 65.4%, and 64.2%, respectively). Multivariate analysis revealed variceal bleeding (subdistribution hazard ratio [sHR], 8.49; 95% confidence interval [CI], 1.56-46.1; P = .013), stent length (sHR, 0.97; 95% CI, 0.95-0.99; P = .008), cumulative time (sHR, 0.32; 95% CI, 0.16-0.65; P = .002), and tumor etiology (sHR, 6.15; 95% CI, 1.02-36.99; P = .047) as independent prognostic factors for patency loss. CONCLUSIONS High technical success rates were achieved with the PMV interventions, with varying long-term patency rates. This study highlights the significance of the initial type of hepatobiliary and pancreatic surgery and clinical variables such as variceal bleeding, stent length, and tumor etiology in influencing PMV stenosis outcomes.
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Affiliation(s)
- Jin Kam Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ahram Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Saebeom Hur
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Myungsu Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hwan Jun Jae
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghyun Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sangil Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
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Kinota N, Abo D, Morita R, Yamasaki K, Fujii T, Kato D, Kimura T, Sakuhara Y, Okada K, Yokota I, Orimo T, Kakisaka T, Nakamura T, Hirano S, Minowa K, Kudo K. Improvement of Hypoalbuminemia and Hepatic Reserve after Stent Placement for Postsurgical Portal Vein Stenosis. J Vasc Interv Radiol 2025; 36:616-624.e2. [PMID: 39667618 DOI: 10.1016/j.jvir.2024.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 11/27/2024] [Accepted: 12/03/2024] [Indexed: 12/14/2024] Open
Abstract
PURPOSE To investigate the change in serum albumin (Alb) levels and hepatic reserve scores before and after portal vein stent placement (PVS) for postsurgical portal vein (PV) stenosis. MATERIALS AND METHODS A retrospective cohort of patients who underwent PVS after abdominal surgery between 2007 and 2021 was analyzed. Patients' age, sex, and PVS technical success (defined by PV patency at final portography) were evaluated. Alb, prothrombin time-international ratio (PT-INR), total bilirubin (Tbili), platelet (Plt) counts, Child-Pugh scores (CPS), and Alb-bilirubin (ALBI) scores/grades before and 1 month after PVS were compared. Normally distributed variables were summarized as mean ± standard deviation (SD) and compared with paired t-tests. Skewed variables were summarized as median (interquartile range) and compared with the signed-rank tests. RESULTS Twenty-five patients (mean age, 61 years [SD ± 10]; female, 44%) were included. Technical success of PVS was achieved in all. Comparison was conducted for 28 PVS sessions: the Alb levels increased from 3.1 g/dL (SD ± 0.6) to 3.5 g/dL (SD ± 0.5) (P = .006), with greatest change in patients with pre-PVS Alb levels of ≤2.9 g/dL (2.6 g/dL ± 0.3 to 3.3 g/dL ± 0.4, P < .001). Improvements in CPS (P = .026), ALBI score (P = .002), and ALBI grades (P = .026) were observed. PT-INR elongated (1.2 [1.1-1.3] to 1.3 [1.2-1.6], P = .002), mainly because of patients receiving post-PVS warfarin (P = .005 and P = .20 for with and without warfarin, respectively). No significant changes were observed for Tbili (P = .40) and Plt counts (P = .25). CONCLUSIONS Improvements of liver synthetic function represented by serum Alb levels and in hepatic reserve scores were observed after PVS, particularly in patients with pre-PVS hypoalbuminemia.
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Affiliation(s)
- Naoya Kinota
- Department of Diagnostic and Interventional Radiology, Sapporo, Japan; Department of Dental Radiology, Sapporo, Japan
| | - Daisuke Abo
- Department of Diagnostic and Interventional Radiology, Sapporo, Japan.
| | - Ryo Morita
- Department of Diagnostic and Interventional Radiology, Sapporo, Japan
| | - Koji Yamasaki
- Department of Diagnostic and Interventional Radiology, Sapporo, Japan
| | - Takaaki Fujii
- Department of Diagnostic and Interventional Radiology, Sapporo, Japan; Department of Dental Radiology, Sapporo, Japan
| | - Daisuke Kato
- Department of Diagnostic and Interventional Radiology, Sapporo, Japan; Department of Dental Radiology, Sapporo, Japan
| | - Tasuku Kimura
- Department of Diagnostic Radiology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Yusuke Sakuhara
- Department of Diagnostic and Interventional Radiology, Tonan Hospital, Sapporo, Japan
| | - Kazufumi Okada
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | | | - Tatsuya Orimo
- Department of Gastroenterological Surgery I, Sapporo, Japan
| | | | - Toru Nakamura
- Department of Gastroenterological Surgery II, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | | | - Kohsuke Kudo
- Department of Diagnostic and Interventional Radiology, Sapporo, Japan; Department of Diagnostic Imaging, Sapporo, Japan; Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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Sakamoto K, Iwamoto Y, Ogawa K, Şal O, Tamura K, Hikida T, Ito C, Iwata M, Sakamoto A, Shine M, Nishi Y, Uraoka M, Nagaoka T, Honjo M, Funamizu N, Takada Y. Impact of reconstructed portal vein morphology on postoperative nutritional status in pancreatoduodenectomy: a computational fluid dynamics study. Surg Today 2025; 55:445-451. [PMID: 39080039 DOI: 10.1007/s00595-024-02903-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 07/02/2024] [Indexed: 02/19/2025]
Abstract
This study evaluated the impact of reconstructed portal vein/superior mesenteric vein (PV/SMV) morphology on the long-term nutritional status following pancreatoduodenectomy (PD) using computational fluid dynamics (CFD). Twenty-four patients who underwent PD with PV/SMV resection and reconstruction without tumor recurrence for over 9 months after the operation were enrolled in the study. Three-dimensional models were constructed from computed tomography images obtained 3-6 months postoperatively. The pressure (p) at the inlet and turbulence dissipation rate (ε) at the outlet were investigated in the models. Patients with values of either p or ε above the upper interquartile range were classified as the poor flow group. The prognostic nutritional index improvement rate was significantly lower at 9 postoperative months in the poor flow group than in the good flow group (P = 0.016). This finding indicates the utility of a CFD analysis for evaluating the reconstructed PV/SMV morphology.
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Affiliation(s)
- Katsunori Sakamoto
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Yukiharu Iwamoto
- Department of Mechanical Engineering, Ehime University Graduate School of Science and Engineering, 3 Bunkyo-Cho, Matsuyama, Ehime, 790-8577, Japan
| | - Kohei Ogawa
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Oğuzhan Şal
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kei Tamura
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Takahiro Hikida
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Chihiro Ito
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Miku Iwata
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Akimasa Sakamoto
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Mikiya Shine
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yusuke Nishi
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Mio Uraoka
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Tomoyuki Nagaoka
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Masahiko Honjo
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Naotake Funamizu
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yasutsugu Takada
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
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Odaira M, Ito N, Iwaita Y, Tanuma K, Harada H. Percutaneous Transhepatic Venous Embolization and Portal Vein Stenting for Ectopic Variceal Bleeding at Choledochojejunostomy After Pancreaticoduodenectomy With Portal Vein Stenosis: A Case Report. Cureus 2024; 16:e75374. [PMID: 39781164 PMCID: PMC11708807 DOI: 10.7759/cureus.75374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2024] [Indexed: 01/12/2025] Open
Abstract
Ectopic varices can result from portal vein stenosis following pancreaticoduodenectomy with concomitant portal vein resection reconstruction, and they can cause gastrointestinal bleeding. Although they can sometimes be fatal, various treatments have been reported. This report describes a case in which a percutaneous transhepatic approach was used to simultaneously perform variceal embolization and portal vein stenting in which a favorable outcome was achieved. The patient was a 77-year-old woman who had undergone subtotal stomach-preserving pancreaticoduodenectomy and portal vein combined resection and reconstruction for stage IIA pancreatic cancer. Although postoperative portal vein stenosis was observed, the patient was followed up because the collateral blood flow was well developed, maintaining intrahepatic blood flow. About 18 months after surgery, the day before a routine outpatient visit, she noticed melena, and a blood test performed at the time of the outpatient visit revealed anemia. An emergency contrast-enhanced computed tomography and an emergency enteroscopy revealed ectopic varices around the elevated jejunum at the choledochojejunostomy, and bleeding from the same site was suspected. Since the patient was suspected to be suffering from portal hypertension, we planned to embolize the varices for bleeding and to place a portal stent to treat portal hypertension. Since the patient had undergone mesh placement for an incisional hernia approximately one year postoperatively, a percutaneous transhepatic route was selected, and the patient was approached via the right portal vein route. The varices were embolized with coils and histoacrylate, and a stent was placed in the stenotic portal vein. The portal vein pressure was measured before and after the procedure to confirm its reduction, and the procedure was completed without complications. The patient was discharged from the hospital seven days after the procedure with no problems and is currently under outpatient follow-up with no varice recurrence. Although the optimal treatment for ectopic varices has not been established, portal vein stenting and variceal embolization via a percutaneous transhepatic approach were effective.
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Affiliation(s)
- Masanori Odaira
- Department of Surgery, Tokyo Saiseikai Central Hospital, Tokyo, JPN
| | - Nobutake Ito
- Department of Radiology, Tokyo Saiseikai Central Hospital, Tokyo, JPN
| | - Yuki Iwaita
- Department of Radiology, Tokyo Saiseikai Central Hospital, Tokyo, JPN
| | - Kota Tanuma
- Department of Gastroenterology, Tokyo Saiseikai Central Hospital, Tokyo, JPN
| | - Hirohisa Harada
- Department of Surgery, Tokyo Saiseikai Central Hospital, Tokyo, JPN
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Ohta M, Kanba R, Fukushima K, Takahashi K, Nishimaki H, Sasaki T, Fujita A, Kanno M, Ogasawara Y, Namiki K. Rapid deterioration of steatotic liver disease due to portal vein stenosis after pancreaticoduodenectomy. Clin J Gastroenterol 2024; 17:1093-1099. [PMID: 39147944 PMCID: PMC11549149 DOI: 10.1007/s12328-024-02027-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 07/23/2024] [Indexed: 08/17/2024]
Abstract
Steatotic liver disease after pancreatoduodenectomy occurs due to various factors, such as exocrine pancreatic insufficiency, impaired intestinal absorption, and malnutrition. The mechanism of steatogenesis differs to that of conventional steatotic liver disease associated with obesity and insulin resistance. We experienced a rare case of rapidly progressive steatotic liver disease accompanied by portal vein stenosis in the early postoperative period after subtotal stomach-preserving pancreaticoduodenectomy for distal cholangiocarcinoma. Although there was a complication due to postoperative drain infection, the patient was discharged from hospital with no nutritional problems. Two months postoperatively, the patient presented to the emergency room with dyspnea. CT showed a markedly steatotic liver, ascites, and portal vein stenosis. A portal vein stent was inserted transhepatically and the steatotic liver disease gradually improved. During the postoperative course, there were no problems indicated by nutritional markers; although the patient had diarrhea associated with postoperative pancreatic exocrine insufficiency, the symptoms were mild and improved after administration of oral pancrelipase. Before the intervention, the patient had intestinal edema, exacerbation of diarrhea, and a low serum zinc concentration, suggesting that impaired absorption caused by intestinal blood stasis and gut barrier dysfunction contributed to the development of steatotic liver disease.
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Affiliation(s)
- Mineto Ohta
- Department of Surgery, Osaki Citizen Hospital, 3-8-1 Honami, Osaki, Miyagi, 989-6183, Japan.
- Department of General Medicine, Osaki Citizen Hospital, 3-8-1 Honami, Osaki, Miyagi, 989-6183, Japan.
| | - Rikiya Kanba
- Department of Surgery, Osaki Citizen Hospital, 3-8-1 Honami, Osaki, Miyagi, 989-6183, Japan
- Department of General Medicine, Osaki Citizen Hospital, 3-8-1 Honami, Osaki, Miyagi, 989-6183, Japan
| | - Keisuke Fukushima
- Department of Surgery, Osaki Citizen Hospital, 3-8-1 Honami, Osaki, Miyagi, 989-6183, Japan
| | - Kazutomi Takahashi
- Department of Surgery, Osaki Citizen Hospital, 3-8-1 Honami, Osaki, Miyagi, 989-6183, Japan
| | - Hiroyasu Nishimaki
- Department of Surgery, Osaki Citizen Hospital, 3-8-1 Honami, Osaki, Miyagi, 989-6183, Japan
| | - Tatsuya Sasaki
- Department of Nutrition, Osaki Citizen Hospital, 3-8-1 Honami, Osaki, Miyagi, 989-6183, Japan
| | - Ai Fujita
- Department of Nutrition, Osaki Citizen Hospital, 3-8-1 Honami, Osaki, Miyagi, 989-6183, Japan
| | - Maika Kanno
- Department of Nutrition, Osaki Citizen Hospital, 3-8-1 Honami, Osaki, Miyagi, 989-6183, Japan
| | - Yuki Ogasawara
- Department of Nutrition, Osaki Citizen Hospital, 3-8-1 Honami, Osaki, Miyagi, 989-6183, Japan
| | - Kenji Namiki
- Department of Surgery, Osaki Citizen Hospital, 3-8-1 Honami, Osaki, Miyagi, 989-6183, Japan
- Department of General Medicine, Osaki Citizen Hospital, 3-8-1 Honami, Osaki, Miyagi, 989-6183, Japan
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Ogawa S, Yamamoto A, Jogo A, Kageyama K, Sohgawa E, Ohira G, Kimura K, Tanaka S, Amano R, Takemura S, Ishizawa T, Miki Y. Embolization with or without portal vein stenting for bleeding ectopic jejunal varices in hepatopetal portal collaterals due to extrahepatic portal vein occlusion or stenosis after hepatobiliary and pancreatic surgery. Jpn J Radiol 2024; 42:1342-1351. [PMID: 38935221 PMCID: PMC11522060 DOI: 10.1007/s11604-024-01616-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To evaluate the efficacy and safety of embolization with or without portal vein stenting for bleeding ectopic jejunal varices in the hepatopetal portal collateral due to extrahepatic portal vein occlusion or stenosis after hepatobiliary and pancreatic surgery. MATERIALS AND METHODS This study included consecutive patients who underwent embolization for bleeding ectopic jejunal varices in the hepatopetal collateral due to extrahepatic portal vein occlusion or stenosis after hepatobiliary and pancreatic surgery between September 2012 and December 2020. The safety, technical and clinical success rates (no re-bleeding within 1 month) and re-bleeding-free survival after the first therapy and overall survival were assessed. RESULTS Fourteen sessions in 11 patients were included. Four patients (7 sessions) underwent variceal embolization only, and the remaining seven patients (7 sessions) underwent portal vein stenting and variceal embolization. Technical success was achieved in all 14 sessions (100%). Clinical success was achieved in 13 of 14 sessions (92.9%). No treatment-related serious complications including liver failure were observed. One-year and 2-year re-bleeding-free survival rate after the first endovascular therapy in all 11 patients was 90.9 and 60.6%, respectively. Two patients who experienced re-bleeding had repeat embolization treatment. There was no significant difference in re-bleeding-free survival after endovascular therapy between the combination with stenting and embolization group and the embolization-only group (p = 0.13). CONCLUSION Embolization with or without portal vein stenting of bleeding ectopic jejunal varices in the hepatopetal portal collateral due to extrahepatic portal vein occlusion or stenosis after hepatobiliary and pancreatic surgery can be considered a safe, effective, and repeatable therapy for long-term hemostasis of uncontrollable bleeding.
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Affiliation(s)
- Satoyuki Ogawa
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
- Department of Diagnostic Radiology, Osaka Saiseikai Nakatsu Hospital, 2-10-39 Shibata, Kita-Ku, Osaka, 530-0012, Japan
| | - Akira Yamamoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan.
| | - Atsushi Jogo
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Ken Kageyama
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Etsuji Sohgawa
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Go Ohira
- Department of Hepato-Biliary-Pancreatic Surgery Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kenjiro Kimura
- Department of Hepato-Biliary-Pancreatic Surgery Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Shogo Tanaka
- Department of Hepato-Biliary-Pancreatic Surgery Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Ryosuke Amano
- Department of Hepato-Biliary-Pancreatic Surgery Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Shigekazu Takemura
- Department of Hepato-Biliary-Pancreatic Surgery Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Takeaki Ishizawa
- Department of Hepato-Biliary-Pancreatic Surgery Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
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Chen L, Wang Z, Dong L, Wang Z, Li Z, Wang W. Comparison of patency rates and complications with or without antithrombotic therapy following portal vein stent placement after pancreatic surgery: a systematic review and meta-analysis. Int J Surg 2024; 110:5771-5780. [PMID: 38818685 PMCID: PMC11392126 DOI: 10.1097/js9.0000000000001755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/19/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Portal vein stent placement is used for portal vein stenosis. However, reports on postpancreatic surgery cases are rare. Whether antithrombotic therapy should be administered remains controversial. In this paper, the authors reviewed current data to evaluate the influence of antithrombosis on stent patency after pancreatic surgery. MATERIALS AND METHODS This systematic review and meta-analysis compared studies in which patients did or did not receive antithrombotic therapy after portal vein stent placement. The authors compared patency after stent placement and complication rate. RESULTS There were 22 ( n =207) studies in which patients received antithrombotic therapy and 8 ( n =61) in which patients did not receive therapy. Antithrombotic agents, such as aspirin, clopidogrel, heparin, and warfarin, were used. The overall patency rates were similar between the groups (79.2% in the antithrombosis group vs. 88.0% in the nonantithrombosis group). Subgroup analyses included those for the etiology of stenosis, types of antithrombotic agents, acute or chronic stenosis, and causes of stent stenosis. None revealed a significant difference between the patency rates in the antithrombosis and nonantithrombosis groups. However, bleeding complications only occurred in patients who received antithrombotic therapy. CONCLUSION There is no significant benefit of antithrombotic therapy after portal vein stent placement following pancreatic surgery. Antithrombotic therapy should be performed with caution because it may cause complications, such as bleeding.
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Affiliation(s)
- Lin Chen
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences
| | - Ziyan Wang
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences
- School of Medicine, Tsinghua University
| | - Liangbo Dong
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences
| | - Zhiwei Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Zehui Li
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences
| | - Weibin Wang
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences
- Key Laboratory of Research in Pancreatic Tumor, Chinese Academy of Medical Sciences
- National Science and Technology Key Infrastructure on Translational Medicine in Peking Union Medical College Hospital, Beijing, People’s Republic of China
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8
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Cuéllar JSS, del Pilar Barón Hernández VA, Martínez AP, Hernández EOS, Escobar RCV, López COV. Endovascular resolution of post-surgical complications in the portal vein: Report of two cases. Radiol Case Rep 2024; 19:2729-2734. [PMID: 38680744 PMCID: PMC11047184 DOI: 10.1016/j.radcr.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 05/01/2024] Open
Abstract
Stenosis of the portal vein is one of the main complications after hepatobiliar and pancreatic surgery, with a reported incidence of 19.6% after pancreaticoduodenectomy and 3% after liver transplant. It is associated with the intraoperative resection of the portal vein, local recurrence of the primary tumor and radiotherapy. The portal lesion secondary to bile drainage catheter insertion is extremely rare or unusual, with few cases described in the literature. This article describes 2 cases: the first of a male patients 49 years old post-operative to liver transplant with partial portal thrombosis and stenosis of the mesoportal joint, and the second a female patient 50 years old with history of cholecystectomy, exploration of the bile duct and placement of Kehr "T" tube with secondary portal lesion. The 2 cases were successfully treated through minimally invasive procedures by an interventionist radiologist.
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Affiliation(s)
- José Sebastián Sotelo Cuéllar
- Hospital Regional 1° de Octubre del ISSSTE, Universidad Nacional Autónoma de México, Av Instituto Politécnico Nacional 1669, Magdalena de las Salinas, Gustavo A. Madero, 07760 Ciudad de México, CDMX, Mexico
| | - Verónica Andrea del Pilar Barón Hernández
- Hospital Regional 1° de Octubre del ISSSTE, Universidad Nacional Autónoma de México, Av Instituto Politécnico Nacional 1669, Magdalena de las Salinas, Gustavo A. Madero, 07760 Ciudad de México, CDMX, Mexico
| | - Alfredo Padilla Martínez
- Hospital Regional 1° de Octubre del ISSSTE, Universidad Nacional Autónoma de México, Av Instituto Politécnico Nacional 1669, Magdalena de las Salinas, Gustavo A. Madero, 07760 Ciudad de México, CDMX, Mexico
| | - Edy Omar Salazar Hernández
- Hospital Regional 1° de Octubre del ISSSTE, Universidad Nacional Autónoma de México, Av Instituto Politécnico Nacional 1669, Magdalena de las Salinas, Gustavo A. Madero, 07760 Ciudad de México, CDMX, Mexico
| | - Roberto Carlos Villanueva Escobar
- Instituto politécnico Nacional, Av. Luis Enrique Erro S/N, Nueva Industrial Vallejo, Gustavo A. Madero, 07738 Ciudad de México, CDMX, Mexico
| | - Cesar Orlando Vidal López
- Hospital Regional General Ignacio Zaragoza ISSSTE, Universidad Nacional Autónoma de México, CP 09220, CDMX, Mexico
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9
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Lin C, Wang ZY, Dong LB, Wang ZW, Li ZH, Wang WB. Percutaneous transhepatic stenting for acute superior mesenteric vein stenosis after pancreaticoduodenectomy with portal vein reconstruction: A case report. World J Gastrointest Surg 2024; 16:1195-1202. [PMID: 38690044 PMCID: PMC11056671 DOI: 10.4240/wjgs.v16.i4.1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/24/2024] [Accepted: 03/19/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Percutaneous transhepatic stent placement has become a common strategy for the postoperative treatment of portal vein (PV)/superior mesenteric veins (SMV) stenosis/occlusion. It has been widely used after liver transplantation surgery; however, reports on stent placement for acute PV/SMV stenosis after pancreatic surgery within postoperative 3 d are rare. CASE SUMMARY Herein, we reported a case of intestinal edema and SMV stenosis 2 d after pancreatic surgery. The patient was successfully treated using stent grafts. Although the stenosis resolved after stent placement, complications, including bleeding, pancreatic fistula, bile leakage, and infection, made the treatment highly challenging. The use of anticoagulants was adjusted multiple times to prevent venous thromboembolism and the risk of bleeding. After careful treatment, the patient stabilized, and stent placement effectively managed postoperative PV/SMV stenosis. CONCLUSION Stent placement is effective and feasible for treating acute PV/SMV stenosis after pancreatic surgery even within postoperative 3 d.
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Affiliation(s)
- Chen Lin
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zi-Yan Wang
- Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Liang-Bo Dong
- Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Zhi-Wei Wang
- Interventional Section, Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Ze-Hui Li
- Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Wei-Bin Wang
- Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
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10
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Maekawa A, Oba A, Inoue Y, Omiya K, Ono Y, Sato T, Watanabe S, Uchino Y, Kobayashi K, Ito H, Sato Y, Tanabe M, Saiura A, Takahashi Y. Technical Strategy for Pancreatic Body Cancers: A Raison d'etre of Distal Pancreatectomy with Portal Resection. Ann Surg Oncol 2024; 31:1347-1357. [PMID: 37952022 DOI: 10.1245/s10434-023-14554-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/22/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Advancements in multiagent chemotherapy have expanded the surgical indications for pancreatic cancer. Although pancreaticoduodenectomy (PD) with portal vein resection (PVR) has become widely adopted, distal pancreatectomy (DP) with PVR remains rarely performed because of its technical complexity. This study was designed to assess the feasibility of DP-PVR compared with PD-PVR for pancreatic body cancers, with a focus on PV complications and providing optimal reconstruction techniques when DP-PVR is necessary. METHODS A retrospective review was conducted on consecutive pancreatic body cancer patients who underwent pancreatectomy with PVR between 2005 and 2020. An algorithm based on the anatomical relationship between the arteries and PV was used for optimal surgical selection. RESULTS Among 119 patients, 32 underwent DP-PVR and 87 underwent PD-PVR. Various reconstruction techniques were employed in DP-PVR cases, including patch reconstruction, graft interposition, and wedge resection. The majority of PD-PVR cases involved end-to-end anastomosis. The length of PVR was shorter in DP-PVR (25 vs. 40 mm; p < 0.001). Although Clavien-Dindo ≥3a was higher in DP-PVR (p = 0.002), inpatient mortality and R0 status were similar. Complete PV occlusion occurred more frequently in DP-PVR than in PD-PVR (21.9% vs. 1.1%; p < 0.001). A cutoff value of 30 mm for PVR length was determined to be predictive of nonrecurrence-related PV occlusion after DP-PVR. The two groups did not differ significantly in recurrence or overall survival. CONCLUSIONS DP-PVR had higher occlusion and postoperative complication rates than PD-PVR. These findings support the proposed algorithm and emphasize the importance of meticulous surgical manipulation when DP-PVR is deemed necessary.
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Affiliation(s)
- Aya Maekawa
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Oba
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yosuke Inoue
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kojiro Omiya
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshihiro Ono
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takafumi Sato
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shuichi Watanabe
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshihiro Uchino
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Kosuke Kobayashi
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiromichi Ito
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yozo Sato
- Department of Diagnostic Ultrasound and Interventional Radiology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, Aichi, Japan
| | - Minoru Tanabe
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akio Saiura
- Department of Hepatobiliary Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yu Takahashi
- Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
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11
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Kaluba B, Kuriyama N, Ito T, Tanemura A, Mizuno S. Inverted Y-shaped technique for complex superior mesenteric / portal vein reconstruction in pancreatoduodenectomy for locally advanced pancreatic head ductal adenocarcinoma. Ann Gastroenterol Surg 2023; 7:684-690. [PMID: 37416737 PMCID: PMC10319611 DOI: 10.1002/ags3.12666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 07/08/2023] Open
Abstract
Most pancreatoduodenectomy (PD) procedures for locally advanced pancreatic head adenocarcinoma (PDAC) require superior mesenteric/portal vein (SMV/PV) axis resection and reconstruction. Here we describe the inverted Y-shaped as a new technique for complex SMV/PV reconstruction and aimed at evaluating its safety and effectiveness. Among 287 patients who underwent PD for locally advanced PDAC from April, 2007 to December, 2020 at our hospital, 11 patients (3.8%) who underwent PV/SMV reconstruction with this technique were enrolled. Briefly, two distal veins were slit-wedged, sutured, resulting in one orifice, then reconstruction was completed with (n = 6) or without (n = 5) interposed autologous right external iliac vein (REIV) grafts, respectively. Operation time and blood loss were 649 (502-822) min and 1782 (475-6680) mL, respectively. The median length of resected SMV/PV was 40 (20-70) mm, 50 (50-70) mm for REIV grafts, and the splenic vein was resected in eight patients. No patient developed pancreatic fistula; mild leg edema was observed in the six graft patients and the median hospital stay was 36.0 d. PV patency rate at 2 mo after PD was 91% (10/11) and no 90-d mortality was recorded. R0 resection rate was 91% (10/11). It is feasible to safely reconstruct the SMV/PV using the inverted Y-shaped technique in appropriately selected PDAC patients.
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Affiliation(s)
- Benson Kaluba
- Department of Hepatobiliary Pancreatic and Transplant SurgeryMie University Graduate School of MedicineTsuJapan
| | - Naohisa Kuriyama
- Department of Hepatobiliary Pancreatic and Transplant SurgeryMie University Graduate School of MedicineTsuJapan
| | - Takahiro Ito
- Department of Hepatobiliary Pancreatic and Transplant SurgeryMie University Graduate School of MedicineTsuJapan
| | - Akihiro Tanemura
- Department of Hepatobiliary Pancreatic and Transplant SurgeryMie University Graduate School of MedicineTsuJapan
| | - Shugo Mizuno
- Department of Hepatobiliary Pancreatic and Transplant SurgeryMie University Graduate School of MedicineTsuJapan
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12
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Nagakawa Y, Jang JY, Kawai M, Kim SC, Inoue Y, Matsuyama R, Heo JS, Honda M, Sugiura T, Ohtsuka M, Mizuno S, Kwon W, Uemura K, Han HS, Sugimoto M, Okano K, Nakamura M, Wada K, Kumamoto Y, Osakae H, Tsuchida A, Yoon YS, Park JS, Yamaue H, Endo I. Surgical Outcomes of Pancreatectomy with Resection of the Portal Vein and/or Superior Mesenteric Vein and Jejunal Vein for Pancreatic Head Cancer: A Multicenter Study. Ann Surg 2023; 277:e1081-e1088. [PMID: 34913900 DOI: 10.1097/sla.0000000000005330] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the safety and survival benefits of portal vein and/or superior mesenteric vein (PV/SMV) resection with jejunal vein resection (JVR) for pancreatic ductal adenocarcinoma (PDAC). SUMMARY BACKGROUND DATA Few studies have shown the surgical outcome and survival of pancreatic resection with JVR, and treatment strategies for patients with PDAC suspected of jejunal vein (JV) infiltration remain unclear. METHODS In total, 1260 patients who underwent pancreatectomy with PV/ SMV resection between 2013 and 2016 at 50 facilities were included; treatment outcomes were compared between the PV/SMV group (PV/ SMV resection without JVR; n = 824), PV/SMV-J1 V group (PV/SMV resection with first jejunal vein resection; n = 394), and PV/SMV-J2,3 V group (PV/SMV resection with second jejunal vein or later branch resection; n = 42). RESULTS Postoperative complications and mortality did not differ between the three groups. The postoperative complication rate associated with PV/ SMV reconstruction was 11.9% in PV/SMV group, 8.6% in PV/SMV-J1 V group, and 7.1% in PV/SMV-J2,3V group; there were no significant differences among the three groups. Overall survival did not differ between PV/SMV and PV/SMV-J1 V groups (median survival; 29.2 vs 30.9 months, P = 0.60). Although PV/SMV-J2,3 V group had significantly shorter survival than PV/SMV group who underwent upfront surgery ( P = 0.05), no significant differences in overall survival of patients who received preoperative therapy. Multivariate survival analysis revealed that adjuvant therapy and R0 resection were independent prognostic factors in all groups. CONCLUSION PV/SMV resection with JVR can be safely performed and may provide satisfactory overall survival with the pre-and postoperative adjuvant therapy.
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Affiliation(s)
- Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Jin-Young Jang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Manabu Kawai
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Song Cheol Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yosuke Inoue
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryusei Matsuyama
- Department of Hepatobiliary-pancreatic surgery, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Jin Seok Heo
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Masayuki Honda
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shugo Mizuno
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Wooil Kwon
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kenichiro Uemura
- Department of Surgery, institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul, Korea
| | - Motokazu Sugimoto
- Department of Hepatobiliary-Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Keiichi Okano
- Department of Gastroenterologi-cal Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yusuke Kumamoto
- Department of Surgery, Kitasato University School of Medicine, Kanagawa, Japan.; and
| | - Hiroaki Osakae
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Akihiko Tsuchida
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul, Korea
| | - Joon Seong Park
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hiroki Yamaue
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Itaru Endo
- Department of Hepatobiliary-pancreatic surgery, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
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13
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D'Silva M, Yoon YS, Lee JS, Cho JY, Lee HW, Lee B, Kim M, Han HS. Incidence, risk factors, and outcomes of jejunal varix of the afferent loop after pancreatoduodenectomy. HPB (Oxford) 2022; 24:2193-2201. [PMID: 36150971 DOI: 10.1016/j.hpb.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 06/13/2022] [Accepted: 08/22/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Jejunal varix is a concerning late complication after pancreatoduodenectomy (PD) due to the risk of recurrent and intractable bleeding. Our aim was to investigate the incidence, risk factors, and outcomes of jejunal varix after PD. METHODS A total of 709 patients who underwent PD between 2007 and 2017 were included. Preoperative and postoperative CT images were reviewed to evaluate the development of portal vein (PV) stenosis (≥50%) and jejunal varices. RESULTS Jejunal varix developed in 83 (11.7%) patients at a median of 12 months after PD. Eighteen (21.7%) patients experienced variceal bleeding. PV stenosis (P < 0.001; odds ratio [OR] 33.2, 95% confidence interval [CI] 15.6-66.7) and PV/superior mesenteric vein resection (P = 0.028; OR 2.3, 95% CI 1.1-4.7) were independent risk factors for jejunal varix. Of the nine patients who underwent stent placement for PV stenosis before the formation of jejunal varices, none experienced variceal bleeding. By contrast, 18 (27.3%) of the 135 patients without PV stent placement experienced at least one episode of variceal bleeding. CONCLUSIONS The incidence of jejunal varix was substantial after PD. PV stenosis was a strong risk factor for jejunal varix. Early PV stent placement and maintaining stent patency could reduce the risk of variceal bleeding in patients with PV stenosis.
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Affiliation(s)
- Mizelle D'Silva
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea.
| | - Jun Suh Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Hae Won Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Boram Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Moonhwan Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
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14
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Wang L, Guo G, Yu J, Lin L, Yang J, Lu B. Confusing delayed hematemesis, unusual arterial hemorrhage after pancreaticoduodenectomy: a case report. J Int Med Res 2022; 50:3000605221109396. [PMID: 35770952 PMCID: PMC9251987 DOI: 10.1177/03000605221109396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pancreaticoduodenectomy (PD) is one of the most complex surgeries and is associated with a high rate of complications, including bleeding, delayed gastric emptying (DGE), and pancreatic fistula. Although the frequency of postoperative hemorrhage is not high, this complication results in severe adverse outcomes. A 67-year-old man was diagnosed with pancreatic cancer and underwent PD. On the tenth day after surgery, he developed hypovolemic shock with hematemesis. Urgent digital subtraction angiography identified the bleeding artery as the jejunal mesenteric artery at the afferent loop, and the bleeding artery was embolized with two coils. After digital subtraction angiography, the patient had an uneventful recovery with no further complications. Therefore, we concluded that it is possible that bleeding may occur in the afferent loop when hemorrhage occurs after PD.
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Affiliation(s)
- Luna Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, China.,Department of Hepatobiliary Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang Province, China
| | - Gaoli Guo
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, China
| | - Jianhua Yu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, China.,Department of Hepatobiliary Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang Province, China
| | - Ling Lin
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, China.,Department of Hepatobiliary Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang Province, China
| | - Jianhui Yang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, China.,Department of Hepatobiliary Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang Province, China
| | - Baochun Lu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, China.,Department of Hepatobiliary Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang Province, China
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15
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Shiozaki S, Matsugu Y, Hamaoka M, Ishimoto T. Superior mesenteric vein to the right testicular vein shunt operation for jejunal varices bleeding associated with extrahepatic portal vein obstruction after pancreaticoduodenectomy: a case report. Surg Case Rep 2022; 8:33. [PMID: 35199245 PMCID: PMC8866587 DOI: 10.1186/s40792-022-01390-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background Causes of extrahepatic portal vein obstruction include abdominal surgeries such as pancreaticoduodenectomy. We improved jejunal variceal bleeding due to extrahepatic portal vein occlusion after pancreaticoduodenectomy, by shunting of the testicular vein. Case presentation A 72-year-old man was diagnosed with extrahepatic bile duct cancer and underwent subtotal stomach-preserving pancreaticoduodenectomy 5 years ago. No postoperative complications occurred, adjuvant chemotherapy using gemcitabine hydrochloride was performed, and the patient remained recurrence-free. One year and 6 months post-operation, extrahepatic portal vein stenosis appeared, but no recurrence was noted. However, 4 years and 6 months later, recurrent gastrointestinal bleeding occurred, and the patient was diagnosed with an extrahepatic portal vein obstruction. Double-balloon enteroscopy showed capillary dilatation and varicose veins in the hepaticojejunostomy region, and venous bleeding from collateral blood vessels was diagnosed. A superior mesenteric vein to the right testicular vein shunt operation was performed, following which the gastrointestinal bleeding disappeared, and the anemia improved. Although transient hepatic encephalopathy occurred, conservative treatment relieved it. Double-balloon enteroscopy confirmed the disappearance of abnormal blood vessels. Conclusions A portosystemic shunt operation using the right testicular vein effectively relieved refractory variceal bleeding around the hepaticojejunostomy site in the jejunum due to an extrahepatic portal vein obstruction after pancreaticoduodenectomy.
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Affiliation(s)
- Shohei Shiozaki
- Department of Gastroenterological, Breast and Transplant Surgery, Hiroshima Prefectural Hospital, 1-5-54, Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Yasuhiro Matsugu
- Department of Gastroenterological, Breast and Transplant Surgery, Hiroshima Prefectural Hospital, 1-5-54, Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan. .,Department of Clinical Nutrition, Hiroshima Prefectural Hospital, Hiroshima, Japan.
| | - Michinori Hamaoka
- Department of Gastroenterological, Breast and Transplant Surgery, Hiroshima Prefectural Hospital, 1-5-54, Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan
| | - Tatsuro Ishimoto
- Department of Gastroenterological, Breast and Transplant Surgery, Hiroshima Prefectural Hospital, 1-5-54, Ujina-Kanda, Minami-ku, Hiroshima, 734-8530, Japan
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16
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Ju Kim Y, Jin Yoon C, Hwan Lee J, Seok Choi W, Yoon YS, Hwang JH, Kim J. Transhepatic stent placement for malignant portal vein obstruction: long term efficacy and factors associated with stent failure. Eur J Radiol 2022; 149:110230. [DOI: 10.1016/j.ejrad.2022.110230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/19/2022] [Accepted: 02/23/2022] [Indexed: 11/24/2022]
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17
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You Y, Heo JS, Han IW, Shin SH, Shin SW, Park KB, Cho SK, Hyun D. Long term clinical outcomes of portal vein stenting for symptomatic portal vein stenosis after pancreaticoduodenectomy. Medicine (Baltimore) 2021; 100:e27264. [PMID: 34596122 PMCID: PMC8483817 DOI: 10.1097/md.0000000000027264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/30/2021] [Indexed: 01/05/2023] Open
Abstract
Gastrointestinal bleeding caused by portal vein (PV) stenosis is serious complication after pancreaticoduodenectomy (PD) The purpose of this study is to reveal the long-term clinical outcomes of PV stenting for symptomatic PV stenosis and risk factors of stent related complication.Fifteen patients who underwent portal vein stenting for symptomatic PV stenosis after PD between 2000 and 2018 were retrospectively reviewed. The whole cohort was divided into 9 patients with benign stenosis group (Group-B) and 6 patients with recurrence group (Group-R).The median follow up period was 17.0 (interquartile range 12.0-38.0) months. The technical success rate and clinical success rate was revealed at 93.3% and 86.7%. The primary patency rate of stents was 79.4% and mean patency period was 14.0 (4.0-28.0) months. There was significant difference in time to stenosis and proportion of anticoagulation treatment between 2 groups [2.0 (1.0-4.0) months vs 18.5 (2.5-50.3) months, P = .035 and 100% vs 50%, P = .044. In univariable analysis, stent diameter was found to have a significant correlation with stent occlusion (P = .036).PV stenting was found to be feasible and safe in the treatment of symptomatic PV stenosis from a long term point of view.
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Affiliation(s)
- Yunghun You
- Department of Surgery, Eulji University School of Medicine, 95, Dunsanseo-ro, Seo-gu, Daejeon, South Korea
| | - Jin Seok Heo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - In Woong Han
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Sang Hyun Shin
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Sung Wook Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Kwang Bo Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Sung Ki Cho
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Dongho Hyun
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
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18
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Reconsideration of the Appropriate Dissection Range Based on Japanese Anatomical Classification for Resectable Pancreatic Head Cancer in the Era of Multimodal Treatment. Cancers (Basel) 2021; 13:cancers13143605. [PMID: 34298818 PMCID: PMC8303207 DOI: 10.3390/cancers13143605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/06/2021] [Accepted: 07/15/2021] [Indexed: 12/11/2022] Open
Abstract
Patients with resectable pancreatic cancer are considered to already have micro-distant metastasis, because most of the recurrence patterns postoperatively are distant metastases. Multimodal treatment dramatically improves prognosis; thus, micro-distant metastasis is considered to be controlled by chemotherapy. The survival benefit of "regional lymph node dissection" for pancreatic head cancer remains unclear. We reviewed the literature that could be helpful in determining the appropriate resection range. Regional lymph nodes with no suspected metastases on preoperative imaging may become areas treated with preoperative and postoperative adjuvant chemotherapy. Many studies have reported that the R0 resection rate is associated with prognosis. Thus, "dissection to achieve R0 resection" is required. The recent development of high-quality computed tomography has made it possible to evaluate the extent of cancer infiltration. Therefore, it is possible to simulate the dissection range to achieve R0 resection preoperatively. However, it is often difficult to distinguish between areas of inflammatory changes and cancer infiltration during resection. Even if the "dissection to achieve R0 resection" range is simulated based on the computed tomography evaluation, it is difficult to identify the range intraoperatively. It is necessary to be aware of anatomical landmarks to determine the appropriate dissection range during surgery.
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Tai Y, Tong H, Wei B, Wu H. Ectopic variceal bleeding after hepatobiliary surgery: A case report. Medicine (Baltimore) 2021; 100:e24975. [PMID: 33655966 PMCID: PMC7939183 DOI: 10.1097/md.0000000000024975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/11/2021] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Jejunal varices are rare in portal hypertension and are often difficult to diagnose and treat. Herein, we present a case of gastrointestinal bleeding due to jejunal varices after hepatobiliary surgery. PATIENT CONCERNS A 69-year-old man presented with recurrent massive gastrointestinal bleeding. He underwent partial right hepatectomy and cholangiojejunostomy 2 years prior to the first onset of bleeding. Two sessions of endoscopic vessel ligation for esophageal varices were performed afterwards, and hematemesis resolved completely, but massive melena still recurred during the following 5 years. DIAGNOSIS The patient was diagnosed with jejunal varices caused by portal venous stenosis after hepatobiliary surgery. INTERVENTION Portal venous angioplasty using balloon dilation and stent implantation was performed. OUTCOMES After the intervention procedure, the patient did not experience any onset of gastrointestinal bleeding during follow-up. LESSONS Hepatopancreatobiliary could lead to the formation of jejunal varices. The combined use of capsule endoscopy, contrast-enhanced computed tomography, and sometimes portal venography is a promising strategy to search for jejunal varices. Transcatheter angioplasty appears to be a safe and effective method for treatment of jejunal varices in certain appropriate cases.
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Affiliation(s)
- Yang Tai
- Department of Gastroenterology
- Laboratory of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Bo Wei
- Department of Gastroenterology
| | - Hao Wu
- Department of Gastroenterology
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Takao S, Hirakawa M, Takeishi K, Motomura Y, Sakamoto K, Otsu H, Yonemura Y, Mimori K, Ishigami K. Portal Vein Stenting for Jejunal Variceal Bleeding after Recurrence of Pancreatic Adenocarcinoma: A Case Report and Review of the Literature. INTERVENTIONAL RADIOLOGY 2021; 6:44-50. [PMID: 35909910 PMCID: PMC9327411 DOI: 10.22575/interventionalradiology.2020-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/07/2021] [Indexed: 02/07/2023]
Abstract
A 73-year-old woman with portal vein stenosis caused by tumor recurrence after pancreatoduodenectomy was treated with stent placement without embolization of the jejunal varix. Anticoagulation therapy using heparin followed by rivaroxaban was administered after the procedure. She continued to receive systemic chemotherapy as an outpatient. Neither restenosis nor stent thrombosis was observed after 7 months. Based on the presented case and literature review, portal vein stenting is an effective treatment option for jejunal variceal bleeding caused by malignant portal venous stricture after pancreaticoduodenectomy. Antithrombotic therapy following portal venous stenting is required to prevent stent thrombosis in the majority of cases, although it has a risk of inducing recurrent variceal bleeding. Adjunctive jejunal variceal embolization can possibly be omitted in selected cases to obtain sufficient portal-SMV flow reconstruction.
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Affiliation(s)
| | | | | | - Yushi Motomura
- Department of Radiology, Kyushu University Beppu Hospital
| | | | - Hajime Otsu
- Department of Surgery, Kyushu University Beppu Hospital
| | | | - Koshi Mimori
- Department of Surgery, Kyushu University Beppu Hospital
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Science, Kyushu University
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21
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Kook Y, Choi M, Park JY, Chung YE, Kim MD, Lee WJ, Kang CM. Neoadjuvant chemotherapy followed by total pancreatectomy with splenectomy and combined vascular resections after preoperative percutaneous transhepatic portal vein stent placement in locally advanced pancreatic cancer with portal vein total obliteration. Ann Hepatobiliary Pancreat Surg 2020; 24:551-556. [PMID: 33234763 PMCID: PMC7691189 DOI: 10.14701/ahbps.2020.24.4.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/04/2022] Open
Abstract
Pancreatic cancer is one of the most lethal malignant diseases in gastrointestinal system that only about 15-20% of the patients are potential candidates for resection at diagnostic stage. However, with the advent of neoadjuvant chemotherapy and advancement of surgical skills, patients with locally advanced pancreatic cancer (LAPC), which were deemed initially unresectable, have undergone margin negative radical resection. Here, we present a case of a patient with LAPC who was previously treated with neoadjuvant FOLFIRINOX and underwent pancreaticoduodenectomy combined with vascular resection after preoperative percutaneous transhepatic portal vein stent placement to relieve of portal vein obliteration. The patient recovered without any complication and was discharged on day 8 postoperatively.
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Affiliation(s)
- Yoonwon Kook
- Division of HBP Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Munseok Choi
- Division of HBP Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Jung Yup Park
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Eun Chung
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Man-Deuk Kim
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Jung Lee
- Division of HBP Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Chang Moo Kang
- Division of HBP Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
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Lee JH, Yoon CJ, Choi WS. Transhepatic stent placement for portal vein obstruction after hepatobiliary and pancreatic surgery: long-term efficacy and risk factor for stent failure. Eur Radiol 2020; 31:1300-1307. [PMID: 32880695 DOI: 10.1007/s00330-020-07139-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/28/2020] [Accepted: 08/03/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate the long-term efficacy of transhepatic portal vein (PV) stent placement in patients with postoperative PV obstruction and to identify risk factors for stent failure. METHODS Between January 2007 and October 2019, percutaneous transhepatic PV stent placement was attempted in 60 patients with postoperative PV obstruction. Technical and clinical success, complications, and stent patency were retrospectively evaluated. Thirteen clinical variables were analyzed to determine risk factors for stent failure. RESULTS Stent placement was technically successful in all patients. Thromboaspiration (n = 19) and jejunal variceal embolization (n = 7) were performed in the same session. Clinical symptoms related to portal hypertension were resolved in 54 patients (90.0%). There was no procedure-related complication. During the follow-up period (mean 630 days), stent failure occurred in 13 patients. One- and 5-year stent patency rate was 74.8% and 64.9%, respectively. The presence of a pancreatic fistula was the only independent risk factor associated with stent failure (HR 7.54; 95% CI 2.02-28.10, p = 0.003). CONCLUSIONS Percutaneous transhepatic PV stent placement is a technically feasible and effective treatment for postoperative PV obstruction. The pancreatic fistula is a risk factor for stent failure. KEY POINTS • Percutaneous transhepatic stent placement is an effective treatment to improve portal hypertension-related symptoms in patients with portal vein obstruction after hepatobiliary and pancreatic surgery. • The pancreatic fistula is an independent risk factor for portal vein stent failure.
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Affiliation(s)
- Jae Hwan Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Chang Jin Yoon
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea. .,Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Won Seok Choi
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
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Han SC, Kim TH, Yang HC, Chong JU. Hepatic artery pseudoaneurysm after pancreaticoduodenectomy treated with coil embolization in combination with portomesenteric venous stenting. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2020. [DOI: 10.18528/ijgii200016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Seung Chul Han
- Division of Vascular and Interventional Radiology, Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Tae Hwan Kim
- Division of Vascular and Interventional Radiology, Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hee Chul Yang
- Division of Vascular and Interventional Radiology, Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jae Uk Chong
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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