Transhepatic stent placement for portal vein obstruction after hepatobiliary and pancreatic surgery: long-term efficacy
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INTERVENTIONAL
Transhepatic stent placement for portal vein obstruction after hepatobiliary and pancreatic surgery: long-term efficacy and risk factor for stent failure Jae Hwan Lee 1 & Chang Jin Yoon 1,2
&
Won Seok Choi 1
Received: 21 April 2020 / Revised: 28 May 2020 / Accepted: 3 August 2020 # European Society of Radiology 2020
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. Keywords Portal vein . Hypertension . Portal . Stents . Fistula
Abbreviations CT Computed tomography HBP Hepatobiliary and pancreatic PD Pancreaticoduodenectomy PTBD Percutaneous transhepatic biliary drainage PV Portal vein
* Chang Jin Yoon [email protected] 1
Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
2
Seoul National University College of Medicine, Seoul, Republic of Korea
Introduction Portal vein (PV) obstruction is one of the major complications following hepatobiliary and pancreatic (HBP) surgery, with reported incidence of 19.6% after pancreaticoduodenectomy (PD) [1] and 3% after liver transplantation [2]. It is known to be associated with intraoperative portal vein resection, local recurrence of the primary tumor, and radiation therapy [3–5]. Surgical treatment including thrombectomy, portal vein resection, and re-transplantation has been limited by technical difficulties due to postsurgical adhesion and long obstructed venous segment [6]. Recently,
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