Search

Purpose: To evaluate the long-term efficacy of stent placement versus balloon angioplasty for portal vein (PV) stenosis in pediatric liver transplant (LT) recipients., Materials and Methods: Fifty patients (<18 years old; median, 14 months) who underwent percutaneous transhepatic balloon angioplasty (n = 12), transhepatic stent placement (n = 18), or intraoperative transmesenteric stent placement (n = 20) between 1994 and 2015 were retrospectively analyzed. The median intervals from LT to percutaneous transhepatic angioplasty, stent, and intraoperative stent were 145 days (range, 27-2072), 98 days (range, 5-2289), and 0 days (range, 0-14), respectively. The primary study endpoint was the primary patency of each group. Secondary study endpoints included procedural complications, functional stent stenosis, and stent fractures., Results: The median clinical follow-up periods were 81 months (range, 13-179), 118 months (range, 65-181), and 112 months (range, 47-168) in each group, respectively. In the angioplasty group, the 1-, 5-, and 10-year primary patency rates were all 75% ± 13%. The corresponding rates were all 100% in the percutaneous transhepatic stent group and 90% ± 7%, 90% ± 7%, and 85% ± 8%, respectively, in the intraoperative transmesenteric stent group (P = .103). Major procedural complications occurred in 4 patients, including 1 case with PV tear after percutaneous transhepatic post-stent angioplasty, and 3 cases with acute PV thrombosis after intraoperative transmesenteric stent. Functional stent stenosis and stent fractures occurred in 1 and 2 patients, respectively., Conclusions: No statistically significant difference was observed between the 3 groups in terms of the long-term primary patency rates. Therefore, angioplasty should be considered first to treat PV stenosis in pediatric LT recipients., (Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate the safety and efficacy of mechanical thrombectomy used as a tool for graft rescue in patients with pancreas graft venous thrombosis (PGVT)., Materials and Methods: Graft venous thrombosis was discovered in 36 (33%) of 110 patients who underwent pancreas transplantation. Percutaneous aspiration thrombectomy was performed in seven patients (mean age, 31 y; range, 15-36 y) who had complete or severe thrombosis of the splenic vein or superior mesenteric vein seen on postoperative computed tomography., Results: Successful evacuation of PGVT was possible in six of seven patients; the thrombus was partially evacuated in one patient. In this patient, subsequent anticoagulation salvaged the graft, rendering primary and secondary technical success rates as 86% and 100%, respectively. As pancreas grafts were successfully functioning in all seven patients within 1 month after endovascular treatment, the clinical success rate was 100%. There were no procedure-related complications. At the last follow-up evaluation, all seven patients were alive with no graft loss (mean follow-up time, 9.4 mo; range, 3.6-22.2 mo)., Conclusions: Endovascular treatment may be considered in patients with severe PGVT to prevent early graft loss., (Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.)