Portal vein stent placement after hepatobiliary and pancreatic surgery
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ORIGINAL ARTICLE
Portal vein stent placement after hepatobiliary and pancreatic surgery Ammar Khan 1,2 & Dyre Kleive 2,3 & Einar Martin Aandahl 1 & Bjarte Fosby 1 & Pål-Dag Line 1,2 & Eric Dorenberg 4 & Steinar Guvåg 1 & Knut Jørgen Labori 3 Received: 1 April 2020 / Accepted: 23 June 2020 # The Author(s) 2020
Abstract Purpose To evaluate the long-term outcomes of percutaneous transhepatic stent placement for portal vein (PV) stenosis after liver transplantation (LT) and hepato-pancreato-biliary (HPB) surgery. Methods Retrospective study of 455 patients who underwent LT and 522 patients who underwent resection of the pancreatic head between June 2011 and February 2016. Technical success, clinical success, patency, and complications were evaluated for both groups. Results A total of 23 patients were confirmed to have postoperative PV stenosis and were treated with percutaneous transhepatic PV stent placement. The technical success rate was 100%, the clinical success rate was 80%, and the long-term stent patency was 91.3% for the entire study population. Two procedure-related hemorrhages and two early stent thromboses occurred in the HPB group while no complications occurred in the LT group. A literature review of selected studies reporting PV stent placement for the treatment of PV stenosis after HPB surgery and LT showed a technical success rate of 78–100%, a clinical success rate of 72– 100%, and a long-term patency of 57–100%, whereas the procedure-related complication rate varied from 0–33.3%. Conclusions Percutaneous transhepatic PV stent is a safe and effective treatment for postoperative PV stenosis/occlusion in patients undergoing LT regardless of symptoms. Due to increased risk of complications, the indication for percutaneous PV stent placement after HPB surgery should be limited to patients with clinical symptoms after an individual assessment. Keywords Portal vein . Interventional radiology . Pancreatoduodenectomy . Liver transplantation . Patency
Introduction Portal vein (PV) stenosis is a well-known complication after liver transplantation (LT), and hepato-pancreato-biliary (HPB) surgery [1–8]. Potential symptoms related to PV stenosis are abdominal pain, liver failure, intractable ascites, and gastrointestinal bleeding [9–11] which render it as a potentially serious condition. Management of postoperative PV stenosis with percutaneous stent placement has previously been
* Ammar Khan [email protected] 1
Department of Transplantation Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo Norway
2
Institute of Clinical Medicine, University of Oslo, Oslo, Norway
3
Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
4
Department of Radiology, Oslo University Hospital, Oslo, Norway
reported to be a viable and less invasive option than laparotomy and surgical revision [12]. Even though PV stenosis is a rare complication after LT [2, 3], it has recently been shown to be as high as 19.6% after pancreatoduodenectomy [13]. Regarding LT, PV stenosis is more f
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