Evaluation of Technical Success,Efficacy, and Safety of Portomesenteric Venous Intervention following Nontransplant Hepatobiliary or Pancreatic Surgery |
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| Institution: | 1. Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905;2. Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905;1. Department of Radiology, Yale University, New Haven, Connecticut;3. Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, Texas;4. Department of Radiology, University of California San Diego Medical Center, La Jolla, California;5. Department of Radiology, University of Arkansas Medical Center, Little Rock, Arkansas;6. Department of Radiology, Florida Hospital, Orlando, Florida;7. Department of Radiology, Kaiser Permanente Medical Center, Fremont, California;1. Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Hospital, 4132 Urasa, Minamiuonuma City, Niigata, 949-7302, Japan;2. Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan;3. Department of Radiology, Okayama University Hospital, Okayama City, Okayama, 700-8558, Japan;4. Department of Radiology, Okayama Red Cross Hospital, Okayama City, Okayama, 700-8607, Japan;5. Department of Gastroenterology and Hepatology, Niigata University Hospital, Niigata City, Niigata, Japan;1. Department of Surgery, Sisters of Charity Hospitals, Buffalo, New York;2. Department of Surgery, Niagara Falls Memorial Medical Center, Niagara Falls, New York;1. Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104;2. Interventional Radiology, Weill Cornell Imaging at New York-Presbyterian, New York, New York;1. Department of Medical and Surgical Sciences and Translational Medicine, St Andrea University Hospital, Sapienza University, Rome, Italy;2. Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d''Azur, France;3. Départment de Chirurgie Générale, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg;4. Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France;5. Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Italy;6. INSERM U1065, Mediterranean Center for Molecular Medicine, Team 8 Hepatic Complications of Obesity, Nice, France;1. Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 800, Chicago, IL, 60611;2. Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 800, Chicago, IL, 60611 |
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| Abstract: | PurposeTo evaluate technical success, efficacy and safety of portomesenteric venous (PMV) intervention for PMV stenosis or occlusion following nontransplant hepatobiliary or pancreatic (HPB) surgery.Materials and MethodsA retrospective review identified 42 patients (mean age 60 y) with PMV stenosis (n = 33; 79%) or occlusion (n = 9; 21%) who underwent attempted PMV intervention following HPB surgery between June 1, 2011, and April 1, 2018. Main outcomes were technical success, primary patency rates, and complications. Technical success was compared by venous pathology and primary PMV patency based on anticoagulation status after the procedure using Fisher exact test. Rates of primary patency by stent group were estimated using Kaplan-Meier method.ResultsTechnical success was 91% (n = 38/42) and significantly higher in patients with stenosis (n = 33/33; 100%) vs occlusion (n = 5/9; 56%) (P = .001). Primary presenting symptom resolved in 28 (87%) patients, including 6 (100%) patients with gastrointestinal bleeding. At mean imaging follow-up of 8.6 months ± 8.8, primary stent patency was 76%. There was no significant difference in primary stent patency based on anticoagulation status after the procedure (P = .48). There were 2 (4.8%) periprocedural complications.ConclusionsPortomesenteric venoplasty and stent placement following nontransplant HPB surgery is safe with a high rate of technical success if performed before chronic occlusion. |
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| Keywords: | HPB"} {"#name":"keyword" "$":{"id":"kwrd0015"} "$$":[{"#name":"text" "_":"hepatobiliary or pancreatic PMV"} {"#name":"keyword" "$":{"id":"kwrd0025"} "$$":[{"#name":"text" "_":"portomesenteric venous PV"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"portal vein SMV"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"superior mesenteric vein |
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