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Kim JH, Kim S, Nam HC, Kim CW, Yoo JS, Han JW, Jang JW, Choi JY, Yoon SK, Chun HJ, Lee SE, Oh JS, Sung PS. Role of Portosystemic Shunt and Portal Vein Stent in Managing Portal Hypertension Due to Hematological Diseases. Cureus 2024; 16:e54206. [PMID: 38496121 PMCID: PMC10942847 DOI: 10.7759/cureus.54206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION Patients with hematological diseases experience complications related to portal hypertension, including life-threatening complications such as variceal bleeding. METHODS We analyzed the prognosis of patients with hematological diseases and portal hypertension treated with transjugular intrahepatic portosystemic shunts (TIPS) or portal vein stents. We retrospectively assessed patients with hematological diseases and portal hypertension who had variceal bleeding. We evaluated the characteristics and prognosis of the enrolled patients. A total of 11 patients with hematological diseases who underwent TIPS, or portal vein stenting, were evaluated. RESULTS The median follow-up period was 420 days. Of the 11 patients, eight showed resolution of portal hypertension and its complications following TIPS, or stent insertion. One patient experienced rebleeding due to incomplete resolution of portal hypertension, and two other patients also experienced rebleeding because they underwent TIPS closure or revision due to repetitive hepatic encephalopathy. CONCLUSION Portosystemic shunt and stent installation are effective treatment options for portal hypertension due to hematological diseases.
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Affiliation(s)
- Ji Hoon Kim
- Gastroenterology and Hepatology, Uijeongbu St. Mary's Hospital, Uijeongbu, KOR
| | - Suho Kim
- Radiology, Seoul St. Mary's Hospital, Seoul, KOR
| | - Hee-Chul Nam
- Gastroenterology and Hepatology, Uijeongbu St. Mary's Hospital, Uijeongbu, KOR
| | - Chang Wook Kim
- The Catholic University of Korea, Internal Medicine, Uijeongbu, KOR
| | - Jae-Sung Yoo
- Gastroenterology and Hepatology, Seoul St. Mary's Hospital, Seoul, KOR
| | - Ji Won Han
- Gastroenterology and Hepatology, Seoul St. Mary's Hospital, Seoul, KOR
| | - Jeong Won Jang
- Gastroenterology and Hepatology, Seoul St. Mary's Hospital, Seoul, KOR
| | - Jong Young Choi
- Gastroenterology and Hepatology, Seoul St. mary's Hospital, Seoul, KOR
| | - Seung Kew Yoon
- Gastroenterology and Hepatology, Seoul St. Mary's Hospital, Seoul, KOR
| | - Ho-Jong Chun
- Radiology, Seoul St. Mary's Hospital, Seoul, KOR
| | - Sung-Eun Lee
- Hematology, Seoul St. Mary's Hospital, Seoul, KOR
| | - Jung-Suk Oh
- Radiology, Seoul St. Mary's Hospital, Seoul, KOR
| | - Pil Soo Sung
- Gastroenterology and Hepatology, Seoul St. Mary's Hospital, Seoul, KOR
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Venuthurimilli AK, Gupta R, Singhal S, Madaan V, Kumar P, Singh A, Sah R, Rastogi H, Vohra S, Sahni R, Bharadwaj R, Kumar K, Malhotra S, Jerat N, Sibal A, Goyal N. Intraoperative portal vein stenting through umbilical vein approach: An innovative salvage procedure for portal vein thrombosis in pediatric liver transplant. Pediatr Transplant 2023; 27:e14427. [PMID: 36324265 DOI: 10.1111/petr.14427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND IPVS is considered a last resort or a salvage procedure in the event of recurrent PV thrombosis despite multiple attempts at redo PV anastomosis. We employed the opened umbilical vein approach to place the stent in the PV and deliver anticoagulation through a catheter. MATERIALS AND METHODS From Jan 2017 to Feb 2022, 150 patients underwent pediatric transplantation at department of liver transplant and hepatobiliary surgery unit, Indraprastha Apollo hospitals, New Delhi. Age, weight, PELD Score, diagnosis, portal vein diameter on preoperative CT, Portal flow after stenting, decrease in spleen size after stenting in follow-up CT were collected from a prospectively maintained data base and reviewed. RESULTS Eight patients underwent IPVS following LDLT (mean age-10.6 ± 2.2 months, mean weight 8.1 ± 1.6, mean PELD score 32.7 ± 7.3). The mean PV diameter on preoperative CT scan was 3.6 mm (range 2.7-5.6 mm). The mean portal flow following stenting was 718.75 cc/min. Percentage reduction in size of the spleen was 26.35% beyond 2nd post-operative week. No patient had recurrent PV thrombosis following IPVS and all maintained an adequate portal flow throughout the immediate postoperative period. Two patients had in-hospital mortality secondary to septic complications. CONCLUSION Umbilical vein approach is technically feasible, easy to manipulate the stent and catheter placement after stenting helps to deliver anticoagulants locally.
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Affiliation(s)
- Arun Kumar Venuthurimilli
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Rigved Gupta
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Saurabh Singhal
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Varun Madaan
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Pradeep Kumar
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Akanand Singh
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Rambabu Sah
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
| | - Harsh Rastogi
- Department of Interventional Radiology, Indraprastha Apollo Hospital, New Delhi
| | - Sandeep Vohra
- Department of Radio-diagnosis, Indraprastha Apollo Hospitals, New Delhi, India
| | - Reeti Sahni
- Department of Radio-diagnosis, Indraprastha Apollo Hospitals, New Delhi, India
| | - Ravi Bharadwaj
- Department of Pediatric Hepatology and Gastroenterology, New Delhi, India
| | - Karunesh Kumar
- Department of Pediatric Hepatology and Gastroenterology, New Delhi, India
| | - Smita Malhotra
- Department of Pediatric Hepatology and Gastroenterology, New Delhi, India
| | - Namit Jerat
- Department of Pediatric Intensive Care, New Delhi, India
| | - Anupam Sibal
- Department of Pediatric Hepatology and Gastroenterology, New Delhi, India
| | - Neerav Goyal
- Liver Transplant and Hepato-Pancreatobiliary Surgery Unit (LTHPS), Indraprastha Apollo Hospitals, New Delhi, India
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Hyodo R, Takehara Y, Mizuno T, Ichikawa K, Ogura Y, Naganawa S. Portal Vein Stenosis Following Liver Transplantation Hemodynamically Assessed with 4D-flow MRI before and after Portal Vein Stenting. Magn Reson Med Sci 2020; 20:231-235. [PMID: 32788504 PMCID: PMC8424031 DOI: 10.2463/mrms.ici.2020-0057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
We present a case of a patient who underwent portal vein (PV) stenting for PV stenosis after a living-donor liver transplantation. A pretreatment 3D cine phase-contrast (4D-flow) MRI showed decreased, though hepatopetal, blood flow in the PV. After stenting, 4D-flow MRI confirmed an improvement in PV flow, with a more homogeneous flow distribution to each hepatic segment. 4D-flow MRI are valuable for understanding the hemodynamics of this area, planning for treatments, and evaluating the outcome of the interventions.
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Affiliation(s)
- Ryota Hyodo
- Department of Radiology, Nagoya University Graduate School of Medicine
| | - Yasuo Takehara
- Department of Radiology, Nagoya University Graduate School of Medicine
| | - Takashi Mizuno
- Department of Medical Technology, Nagoya University Hospital
| | | | - Yasuhiro Ogura
- Department of Transplantation Surgery, Nagoya University Hospital
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine
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Madhusudhan K, Agrawal N, Srivastava DN, Pal S, Gupta AK. Percutaneous transhepatic portal vein stenting in a patient with benign non-transplant postoperative portal vein stenosis: A case report. Indian J Radiol Imaging 2014; 23:351-3. [PMID: 24604941 PMCID: PMC3932579 DOI: 10.4103/0971-3026.125622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Extrahepatic portal vein stenosis is caused by a variety of benign and malignant diseases and results in development of symptoms due to portal hypertension. Benign post-surgical adhesions causing portal vein stenosis in non-transplant population is an uncommon etiology of portal hypertension. Endovascular treatment of such patients with angioplasty and stenting is uncommonly reported in literature. We report a case of portal hypertension caused by benign postoperative portal vein fibrosis, successfully treated by self-expandable metallic stent.
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Affiliation(s)
- Ks Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Nikhil Agrawal
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Deep N Srivastava
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sujoy Pal
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Arun K Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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