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Recanalization of Chronic Portal Vein Occlusion in Pediatric Liver Transplant Patients
- Source :
- Journal of Vascular and Interventional Radiology. 30:885-891
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- Purpose To evaluate technical and clinical success and report long-term outcomes of portal vein (PV) recanalization in pediatric orthotopic liver transplant (OLT) patients with chronic PV occlusion. Materials and Methods This is a retrospective review of 15 OLT patients (5 males) with chronic PV occlusion who underwent PV recanalization (33 procedures) between October 2011 and February 2018. Median age was 4.5 years (range, 1–16 years); median weight was 16.6 kg (range, 11.5–57.3 kg). Median time interval from OLT to first intervention was 3.25 years (range, 0.6–15.7 years). Clinical presentations included hypersplenism (n = 12), gastrointestinal bleeding (n = 9), and ascites (n = 3). One patient had incidental diagnosis of PV occlusion. Primary, primary-assisted, and secondary patency at 3, 6, 12, and 24 months were evaluated. Results Technically successful PV recanalization and reduction of PV pressure gradient to ≤ 5 mm Hg was performed in 13/15 patients (87%). Ten of 15 (67%) patients had successful recanalization with the first attempt. Clinical success, defined as improvement in signs and symptoms of portal hypertension, was achieved in 12/13 (92%) patients. Five of 33 (15%) major complications (Society of Interventional Radiology class C), including perisplenic hematoma (n = 2), hemoperitoneum (n = 2), and hepatic artery pseudo aneurysm (n = 1), were managed with pain medication and blood product replacement. Median follow-up was 22 months (range, 1–77 months). Median primary patency was 5 months. Primary patency at 3, 6, 12, and 24 months was 53.8%, 46.2%, 38.5%, and 30.8%, respectively. Primary-assisted patency was 84.6%, 76.9%, 53.8%, and 46.2%, respectively. Secondary patency was 92.3%, 84.6%, 53.8%, and 46.2%, respectively. Conclusions PV recanalization is a safe and effective minimally invasive option in the management of chronic PV occlusion after pediatric OLT.
- Subjects :
- Male
medicine.medical_specialty
Gastrointestinal bleeding
Time Factors
Adolescent
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Hematoma
Ascites
Occlusion
medicine
Humans
Radiology, Nuclear Medicine and imaging
Vascular Diseases
Hemoperitoneum
Child
Vascular Patency
Retrospective Studies
medicine.diagnostic_test
Portal Vein
business.industry
Infant
Interventional radiology
medicine.disease
Liver Transplantation
Surgery
Treatment Outcome
medicine.anatomical_structure
Child, Preschool
030220 oncology & carcinogenesis
Chronic Disease
Portal hypertension
Female
Stents
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Angioplasty, Balloon
Artery
Subjects
Details
- ISSN :
- 10510443
- Volume :
- 30
- Database :
- OpenAIRE
- Journal :
- Journal of Vascular and Interventional Radiology
- Accession number :
- edsair.doi.dedup.....4bf80296c643808841bfa7a12d6e61d4