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Lin C, Wang ZY, Dong LB, Wang ZW, Li ZH, Wang WB. Percutaneous transhepatic stenting for acute superior mesenteric vein stenosis after pancreaticoduodenectomy with portal vein reconstruction: A case report. World J Gastrointest Surg 2024; 16:1195-1202. [PMID: 38690044 PMCID: PMC11056671 DOI: 10.4240/wjgs.v16.i4.1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/24/2024] [Accepted: 03/19/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Percutaneous transhepatic stent placement has become a common strategy for the postoperative treatment of portal vein (PV)/superior mesenteric veins (SMV) stenosis/occlusion. It has been widely used after liver transplantation surgery; however, reports on stent placement for acute PV/SMV stenosis after pancreatic surgery within postoperative 3 d are rare. CASE SUMMARY Herein, we reported a case of intestinal edema and SMV stenosis 2 d after pancreatic surgery. The patient was successfully treated using stent grafts. Although the stenosis resolved after stent placement, complications, including bleeding, pancreatic fistula, bile leakage, and infection, made the treatment highly challenging. The use of anticoagulants was adjusted multiple times to prevent venous thromboembolism and the risk of bleeding. After careful treatment, the patient stabilized, and stent placement effectively managed postoperative PV/SMV stenosis. CONCLUSION Stent placement is effective and feasible for treating acute PV/SMV stenosis after pancreatic surgery even within postoperative 3 d.
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Affiliation(s)
- Chen Lin
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zi-Yan Wang
- Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Liang-Bo Dong
- Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Zhi-Wei Wang
- Interventional Section, Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Ze-Hui Li
- Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Wei-Bin Wang
- Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China
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Fujimoto K, Kondo T, Unozawa H, Koizumi J, Kato N. First Experience With the Utility of ReMAP (Repeatable Microcatheter Access Port) in Portal Vein Stenting. Cureus 2024; 16:e58530. [PMID: 38770468 PMCID: PMC11103942 DOI: 10.7759/cureus.58530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
Portal vein stenting is a treatment option for portal hypertension caused by extrahepatic portal vein obstruction or stenosis. However, limited pathways to approach the portal vein are available, hindering re-intervention in the portal vein. Portal vein puncture through the transjugular intrahepatic portosystemic shunt route is less invasive and considered suitable for portal vein stenting. Furthermore, transjugular intrahepatic portosystemic shunting facilitates repeat approaches to the portal vein. However, a transjugular intrahepatic portosystemic shunt stent is not recommended unless necessary because of adverse events, and cannot be retrieved, once placed. Herein, we report on a novel approach using the repeatable microcatheter access port: ReMAP™ (Toray, Tokyo, Japan), a central vein port into which a 2.9 Fr catheter can be inserted. We used it for a repeat approach to the portal vein with only one puncture and without placing a transjugular intrahepatic portosystemic shunt stent.
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Affiliation(s)
| | | | | | | | - Naoya Kato
- Gastroenterology, Chiba University, Chiba, JPN
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Luo J, Li M, Wu J, Wang H, Pan T, Wu C, Chen J, Huang M, Jiang Z. Transjugular intrahepatic portosystemic shunt for portal hypertension with chronic portal vein occlusion. Eur J Radiol 2024; 171:111316. [PMID: 38237521 DOI: 10.1016/j.ejrad.2024.111316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 11/07/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE This study aims to evaluate the long-term patency of transjugular intrahepatic portosystemic shunt (TIPS) and determine the predictors of shunt dysfunction in patients with chronic portal vein occlusion (CPVO). METHOD This retrospective study was conducted from December 2010 to December 2020 in patients with portal hypertension and CPVO. Patients were followed up from initial TIPS insertion to December 2022 or death. Details of TIPS procedure, adverse events and clinical outcomes were recorded. The cumulative rate of shunt patency was calculated by the Kaplan-Meier method and compared by using the log-rank test. Independent predictors of shunt dysfunction were calculated with the Cox regression model. A nomogram comprising independent variables was developed to enhance the predictive accuracy of shunt patency. RESULTS One hundred six patients (mean age, 45.3 years ± 13.6; 71 males and 35 females) were enrolled in the study. TIPS procedure was technically successful in 100 of 106 patients (94.3 %). The primary shunt patency rates for all 100 patients were 78.9 %, 74.7 %, 67.2 %, and 62.4 % at 6, 12, 24, and 36 months, respectively, and the overall shunt patency rates were 88.9 %, 86.8 %, 83.6 %, and 81.2 % at 6, 12, 24, and 36 months, respectively. Independent predictor of shunt dysfunction were inadequate inflow from superior mesenteric vein or splenic vein (the maximum diameter < 8 mm) and platelet count ≥ 300 × 109/L. The developed nomogram is a simple tool for accurately predicting shunt patency. CONCLUSIONS In patients with CPVO, inadequate inflow and high platelet count are important factors for TIPS dysfunction.
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Affiliation(s)
- Junyang Luo
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, PR China
| | - Mingan Li
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, PR China
| | - Jialin Wu
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, PR China
| | - Haofan Wang
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, PR China
| | - Tao Pan
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, PR China
| | - Chun Wu
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, PR China
| | - Junwei Chen
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, PR China
| | - Mingsheng Huang
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, PR China.
| | - Zaibo Jiang
- Department of Interventional Radiology, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, PR China.
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Lee JS, Lee JY, Sul Y, Kim SH, Ye JB, Yoon SY, Seok J, Han J, Choi JH, Kim HR, Kim Y. Successful endovascular treatment of an obstruction following the surgical repair of a traumatic portal vein injury: a case report. J Int Med Res 2023; 51:3000605231218954. [PMID: 38140951 DOI: 10.1177/03000605231218954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
Traumatic portal vein injury is rare, but the associated mortality rate ranges from 50% to 70%. The management of this injury is difficult and remains controversial. In this case report, we describe the successful endovascular treatment of an obstruction that developed following the surgical repair of a traumatic portal vein injury. A man in his mid-40s who had been injured in a car accident presented to our trauma center with abdominal pain, abdominal distension, and open wounds over both knees. Emergency laparotomy revealed a longitudinal rupture from the upper border of the pancreas to the mid-portion of the portal vein; his hemorrhage was successfully controlled surgically. However, postoperative abdominal computed tomography imaging revealed portal vein obstruction. One week after admission to the intensive care unit, an endovascular stent was successfully inserted into the patient's portal vein via a percutaneous transhepatic approach. The associated injuries, including the distal common bile duct obstruction, were successfully managed by choledochojejunostomy. The patient's postoperative recovery was uneventful. Thus, endovascular stent placement is an effective and safe means of treating an obstruction following the surgical repair of a traumatic portal vein injury.
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Affiliation(s)
- Jin Suk Lee
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jin Young Lee
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Trauma Surgery, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Younghoon Sul
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
- Department of Trauma Surgery, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Se Heon Kim
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jin Bong Ye
- Deparment of Trauma Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Su Young Yoon
- Department of Cardiovascular and Thoracic Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Junepill Seok
- Department of Cardiovascular and Thoracic Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jonghee Han
- Department of Cardiovascular and Thoracic Surgery, Trauma Center, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jung Hee Choi
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hong Rye Kim
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Yook Kim
- Department of Radiology, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
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Antithrombotic Therapy After Venous Interventions: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2022; 219:175-187. [PMID: 35352572 DOI: 10.2214/ajr.22.27413] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Interventions for thrombotic and nonthrombotic venous disorders have increased with technical advances and more trained venous specialists. Antithrombotic therapy is essential to clinical and procedural success; however, post-procedural therapeutic regimens exhibit significant heterogeneity due to limited prospective randomized data as well as incomplete mechanistic understanding of the critical factors driving long-term patency. Post-interventional antithrombotic therapy for thrombotic venous disorders should adhere to existing venous thromboembolism management guidelines, which include 3-6 months of therapeutic anticoagulation at minimum and consideration of extended therapy in patients with higher risk of thrombosis due to procedural or patient factors. The additive benefit of antiplatelet agents in the acute and intermediate period is unknown, having shown improved long-term stent patency in some retrospective studies. Dual and/or triple agent therapy should be limited based on individual risks of thrombosis and bleeding. The treatment of non-thrombotic disorders is more heterogeneous, though patients with limited flow, extensive stent material, or underlying prothrombotic states such as malignancy or chronic inflammation may benefit from single- or multi-agent antithrombotic therapy. However, the agent, dose, and duration of therapy remain indeterminate. Future prospective studies are warranted to improve patient risk stratification and standardize post-procedural antithrombotic therapy in patients receiving venous interventions.
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