• Humans
• Portal Vein
• Venous Thrombosis/diagnosis
• Venous Thrombosis/therapy
• Hypertension, Portal/diagnosis
• Hypertension, Portal/therapy
• Hypertension, Portal/etiology
• Hypertension, Portal/complications
• Risk Factors
• Anticoagulants/therapeutic use
• Liver Cirrhosis/complications
• Liver Cirrhosis/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Gastrointestinal Hemorrhage/diagnosis
• Pregnancy
• Female
• Quality of Life

• Angioplasty
• Embolization
• Portal
• Spleen
• Splenic vein
• TIPS
• Transhepatic
• Transmesenteric
• Transsplenic
• Varices

• Humans
• Female
• Male
• Retrospective Studies
• Portal Vein
• Middle Aged
• Adult
• Aged
• Portasystemic Shunt, Transjugular Intrahepatic/methods
• Embolization, Therapeutic/methods
• Spleen/diagnostic imaging
• Splenic Vein/diagnostic imaging
• Thrombectomy/methods
• Hypertension, Portal

• Case report
• Pancreaticoduodenectomy
• Portal vein reconstruction
• Portal vein stenosis
• Portal vein stent

• Anticoagulants
• Humans
• Hypertension, Portal/complications
• Hypertension, Portal/diagnostic imaging
• Liver Cirrhosis/complications
• Liver Transplantation
• Portal Vein/diagnostic imaging
• Venous Thrombosis/diagnostic imaging
• Venous Thrombosis/therapy

Chronic extrahepatic non-tumoral thrombotic portal vein occlusion in non-cirrhotic patients is a rare condition, affecting 5–10% of patients with portal hypertension.

The present study reports the case of a young patient without previous comorbidities who presented with portal hypertension secondary to chronic extrahepatic non-tumoral thrombotic occlusion of the portal vein. He underwent portal recanalization with a 12 × 80 mm nitinol self-expandable stent and embolization of esophagogastric varices with fibrous springs and cyanoacrylate via transparieto-hepatic access. Immediate resolution of the trans-lesion pressure gradient was obtained transoperatively, while complete remission of esophagogastric varices was verified by endoscopic control during outpatient follow-up.

Chronic portal vein occlusion is associated or not with liver cirrhosis. The chronic phase is characterized by cavernomatous transformation of the portal vein, which consists of the formation of multiple collaterals that bypass the lesion. This phase usually courses with portal hypertension and consequent variceal gastrointestinal bleeding. Decompression of the portal system through direct recanalization (angioplasty with stenting) is one therapeutic options.

We conclude that, in the present case, resolving portal hypertension by direct portal recanalization was a good therapeutic option, as it decompressed the portal system while maintaining the hepatopetal flow.

•

Chronic extrahepatic non-tumoral thrombotic portal occlusion is a rare condition.

Portal hypertension is defined by an increase in the portosystemic venous gradient. In most cases, increased resistance to portal blood flow is the initial cause of elevated portal pressure. More than 90% of cases of portal hypertension are estimated to be due to advanced chronic liver disease or cirrhosis. Transjugular intrahepatic portosystemic shunts, a non-pharmacological treatment for portal hypertension, involve the placement of a stent between the portal vein and the hepatic vein or inferior vena cava which helps bypass hepatic resistance. Portal hypertension may also be a result of extrahepatic portal vein thrombosis or compression. In these cases, percutaneous portal vein recanalisation restores portal trunk patency, thus preventing portal hypertension-related complications. Any portal blood flow impairment leads to progressive parenchymal atrophy and triggers hepatic regeneration in preserved areas. This provides the rationale for using portal vein embolisation to modulate hepatic volume in preparation for extended hepatic resection. The aim of this paper is to provide a comprehensive evidence-based review of the rationale for, and outcomes associated with, the main imaging-guided interventions targeting the portal vein, as well as to discuss the main controversies around such approaches.

Pancreatic pseudocyst formation, arterial pseudoaneurysm, and splanchnic vein thrombosis are complications of chronic pancreatitis that account for significant morbidity and mortality in this patient population. While the short-term utility of timely endovascular intervention for treating the vascular complications of chronic pancreatitis have been relatively well documented, there is a paucity of longitudinal follow-up in this patient population, therefore making it difficult to predict the long-term efficacy of these interventions. This report details a case of a gastroduodenal artery pseudoaneurysm embolization followed by symptomatic superior mesenteric vein chronic thrombosis treated by stent dilatation in a patient with chronic pancreatitis, with 7 years clinical and imaging follow-up.

Causes of extrahepatic portal vein obstruction include abdominal surgeries such as pancreaticoduodenectomy. We improved jejunal variceal bleeding due to extrahepatic portal vein occlusion after pancreaticoduodenectomy, by shunting of the testicular vein.

A 72-year-old man was diagnosed with extrahepatic bile duct cancer and underwent subtotal stomach-preserving pancreaticoduodenectomy 5 years ago. No postoperative complications occurred, adjuvant chemotherapy using gemcitabine hydrochloride was performed, and the patient remained recurrence-free. One year and 6 months post-operation, extrahepatic portal vein stenosis appeared, but no recurrence was noted. However, 4 years and 6 months later, recurrent gastrointestinal bleeding occurred, and the patient was diagnosed with an extrahepatic portal vein obstruction. Double-balloon enteroscopy showed capillary dilatation and varicose veins in the hepaticojejunostomy region, and venous bleeding from collateral blood vessels was diagnosed. A superior mesenteric vein to the right testicular vein shunt operation was performed, following which the gastrointestinal bleeding disappeared, and the anemia improved. Although transient hepatic encephalopathy occurred, conservative treatment relieved it. Double-balloon enteroscopy confirmed the disappearance of abnormal blood vessels.

A portosystemic shunt operation using the right testicular vein effectively relieved refractory variceal bleeding around the hepaticojejunostomy site in the jejunum due to an extrahepatic portal vein obstruction after pancreaticoduodenectomy.

• Pancreaticoduodenectomy
• Portal vein obstruction
• Shunt operation
• Testicular vein
• Variceal bleeding

• patency
• portal vein
• stent
• varix
• venous stenosis

• Aged
• Constriction, Pathologic/surgery
• Female
• Humans
• Male
• Middle Aged
• Pancreaticoduodenectomy
• Portal Vein/surgery
• Postoperative Complications/surgery
• Retrospective Studies
• Risk Factors
• Stents/adverse effects
• Time Factors
• Treatment Outcome
• Vascular Diseases/surgery

• Mesocaval
• Non-selective
• Portocaval
• Selective
• Shunt
• Splenorenal
• Surgical

A 73-year-old woman with portal vein stenosis caused by tumor recurrence after pancreatoduodenectomy was treated with stent placement without embolization of the jejunal varix. Anticoagulation therapy using heparin followed by rivaroxaban was administered after the procedure. She continued to receive systemic chemotherapy as an outpatient. Neither restenosis nor stent thrombosis was observed after 7 months. Based on the presented case and literature review, portal vein stenting is an effective treatment option for jejunal variceal bleeding caused by malignant portal venous stricture after pancreaticoduodenectomy. Antithrombotic therapy following portal venous stenting is required to prevent stent thrombosis in the majority of cases, although it has a risk of inducing recurrent variceal bleeding. Adjunctive jejunal variceal embolization can possibly be omitted in selected cases to obtain sufficient portal-SMV flow reconstruction.

To evaluate the long-term outcomes of percutaneous transhepatic stent placement for portal vein (PV) stenosis after liver transplantation (LT) and hepato-pancreato-biliary (HPB) surgery.

Retrospective study of 455 patients who underwent LT and 522 patients who underwent resection of the pancreatic head between June 2011 and February 2016. Technical success, clinical success, patency, and complications were evaluated for both groups.

A total of 23 patients were confirmed to have postoperative PV stenosis and were treated with percutaneous transhepatic PV stent placement. The technical success rate was 100%, the clinical success rate was 80%, and the long-term stent patency was 91.3% for the entire study population. Two procedure-related hemorrhages and two early stent thromboses occurred in the HPB group while no complications occurred in the LT group. A literature review of selected studies reporting PV stent placement for the treatment of PV stenosis after HPB surgery and LT showed a technical success rate of 78–100%, a clinical success rate of 72–100%, and a long-term patency of 57–100%, whereas the procedure-related complication rate varied from 0–33.3%.

Percutaneous transhepatic PV stent is a safe and effective treatment for postoperative PV stenosis/occlusion in patients undergoing LT regardless of symptoms. Due to increased risk of complications, the indication for percutaneous PV stent placement after HPB surgery should be limited to patients with clinical symptoms after an individual assessment.

• Interventional radiology
• Liver transplantation
• Pancreatoduodenectomy
• Patency
• Portal vein

Deprivation of portal blood flow decreases the hepatic function, thus hepatobiliary cancer patients with total occlusion of the main portal vein (PV) are usually not indicated for major hepatectomy. We herein present a 37-year-old male patient with advanced intrahepatic cholangiocarcinoma, in whom right trisectionectomy was indicated. However, the main PV was nearly completely occluded by tumor invasion, thus resolution of jaundice was markedly slow. To restore the liver function through PV recanalization, a wall stent was inserted percutaneously. Jaundice resolved progressively after PV stenting. Right trisectionectomy, caudate lobectomy, bile duct resection, and en bloc PV segmental resection with iliac vein homograft interposition were performed. However, PV thrombosis developed at the site of PV stent removal, thus a new wall stent was inserted during the operation. The pathology report presented that the tumor was a 5.2 cm-sized well-differentiated adenocarcinoma of periductal infiltrating type with lymph node metastasis. During the follow-up, the interposed PV segment with a wall stent was gradually occluded with development of portal collaterals. At 5 years after surgery, the PV stent was completely occluded and collaterals developed. The patient experienced repetition of febrile episodes of unknown causes. He is currently alive for 8 years with no evidence of tumor recurrence. The detailed surgical procedures were presented with a supplementary video clip of 5 minutes.

• Intahepatic cholangiocarcinoma
• Interposition
• Portal vein
• Right trisectionectomy
• Stent

• Adult
• Aged
• Constriction, Pathologic/etiology
• Female
• Humans
• Hypertension, Portal/complications
• Male
• Middle Aged
• Pancreatic Fistula/complications
• Pancreaticoduodenectomy/adverse effects
• Portal Vein/pathology
• Postoperative Complications/etiology
• Retrospective Studies
• Stents

Like standard stenting in an unresectable malignant stricture of the biliary or digestive tract, minimally invasive modality for portal stenosis is indispensable for palliation. We describe here a safe and practical procedure of portal stenting in a case of metastatic hilar strictures developed nine years after the radical resection of sigmoid colon cancer. After urgent delivery of the biliary tract stenting for the relief of jaundice, the patient received palliative stenting for the stricture of the portal trunk. Transhepatic approach, via the anterior branch, of the portal vein intervention may fit into the standard aspects for portal stenting.

• metastatic hilar stricture
• palliative multi-stenting
• portal stenting

• Esophageal and gastric varices
• Interventional radiology
• Portal hypertension
• Stents

• Adolescent
• Adult
• Aged
• Ascites/surgery
• Child
• Esophageal and Gastric Varices/surgery
• Female
• Humans
• Hypertension, Portal/complications
• Hypertension, Portal/mortality
• Hypertension, Portal/pathology
• Male
• Middle Aged
• Portal Vein/pathology
• Quality of Life/psychology
• Retrospective Studies
• Stents
• Survival Analysis
• Young Adult

• Child
• Interventional radiology
• Liver transplant
• Portal vein
• Stent
• Transsplenic endovascular recanalization
• Varices

• Gastrointestinal hemorrhage
• duodenum/surgery
• hypertension
• portal
• portal vein
• stents
• therapeutic embolization

• Angiography
• CT enterography
• Crohn disease
• GI bleeding
• MR enterography
• PET/MRI

To evaluate portal vein (PV) stenosis and stent patency after hepatobiliary and pancreatic surgery, using abdominal computed tomography (CT).

Percutaneous portal venous stenting was attempted in 22 patients with significant PV stenosis (> 50%) - after hepatobiliary or pancreatic surgery - diagnosed by abdominal CT. Stents were placed in various stenotic lesions after percutaneous transhepatic portography. Pressure gradient across the stenotic segment was measured in 14 patients. Stents were placed when the pressure gradient across the stenotic segment was > 5 mmHg or PV stenosis was > 50%, as observed on transhepatic portography. Patients underwent follow-up abdominal CT and technical and clinical success, complications, and stent patency were evaluated.

Stent placement was successful in 21 patients (technical success rate: 95.5%). Stents were positioned through the main PV and superior mesenteric vein (n = 13), main PV (n = 2), right and main PV (n = 1), left and main PV (n = 4), or main PV and splenic vein (n = 1). Patients showed no complications after stent placement. The time between procedure and final follow-up CT was 41-761 d (mean: 374.5 d). Twenty stents remained patent during the entire follow-up. Stent obstruction - caused by invasion of the PV stent by a recurrent tumor - was observed in 1 patient in a follow-up CT performed after 155 d after the procedure. The cumulative stent patency rate was 95.7%. Small in-stent low-density areas were found in 11 (55%) patients; however, during successive follow-up CT, the extent of these areas had decreased.

Percutaneous transhepatic stent placement can be safe and effective in cases of PV stenosis after hepatobiliary and pancreatic surgery. Stents show excellent patency in follow-up abdominal CT, despite development of small in-stent low-density areas.

• Liver
• Vein
• Stent
• Computed tomography
• Surveillance
• Efficace

• Adult
• Aged
• Angioplasty, Balloon/adverse effects
• Angioplasty, Balloon/instrumentation
• Computed Tomography Angiography
• Constriction, Pathologic
• Digestive System Surgical Procedures/adverse effects
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Phlebography/methods
• Portal Pressure
• Portal Vein/diagnostic imaging
• Portal Vein/physiopathology
• Portography/methods
• Retrospective Studies
• Stents
• Time Factors
• Treatment Outcome
• Vascular Diseases/diagnostic imaging
• Vascular Diseases/etiology
• Vascular Diseases/physiopathology
• Vascular Diseases/therapy
• Vascular Patency

• Portal hypertension
• Radiofrequency ablation
• Stenosis
• Stents

• Abdomen/GI
• Angioplasty
• Mesentery
• Percutaneous
• Stents

• Adult
• Aged
• Contrast Media
• Embolization, Therapeutic/methods
• Enbucrilate/therapeutic use
• Ethiodized Oil
• Feasibility Studies
• Female
• Fluoroscopy
• Hemostasis, Surgical
• Humans
• Male
• Middle Aged
• Portal Vein
• Treatment Outcome

Extrahepatic portal vein stenosis is caused by a variety of benign and malignant diseases and results in development of symptoms due to portal hypertension. Benign post-surgical adhesions causing portal vein stenosis in non-transplant population is an uncommon etiology of portal hypertension. Endovascular treatment of such patients with angioplasty and stenting is uncommonly reported in literature. We report a case of portal hypertension caused by benign postoperative portal vein fibrosis, successfully treated by self-expandable metallic stent.

• Portal hypertension
• portal vein stenosis
• portal vein stenting

A 14-year-old girl, with no medical history except for a preterm birth at 7 months, presented with clinical and laboratory signs of pancytopenia. Radiological investigation, including abdominal ultrasound and magnetic resonance imaging revealed a focal irregular main portal vein wall and splenomegaly. Endoscopy showed major esophageal and gastric varices. Definitive diagnosis was made by direct, transhepatic portography revealing a focal stenosis associated with a dissection of the main portal vein. Percutaneous treatment including balloon angioplasty and stent placement resulted in complete re-expansion of the portal vein main branch. Clinical and radiological follow-up over 5 years showed complete disappearance of all clinical signs and normalization of laboratory data and splenic volume.

• Portal hypertension
• endoscopy
• liver
• percutaneous intervention
• stent

Extrahepatic portal vein (PV) stenosis has various causes, such as tumor encasement, pancreatitis and as a post-surgical complication. With regard to post-pancreaticoduodenectomy, intraoperative radiation therapy with/without PV resection is reported to be associated with PV stenosis. However, there has been no report of PV stenosis after pancreatectomy following neoadjuvant chemoradiation therapy (NACRT). Here we report the cases of three patients with PV stenosis after pancreatectomy and PV resection following gemcitabine-based NACRT for pancreatic cancer and their successful treatment with stent placement. We have performed NACRT in 18 patients with borderline resectable pancreatic cancer since 2005. Of the 15 patients who completed NACRT, nine had undergone pancreatectomy. Combined portal resection was performed in eight of the nine patients. We report here three patients with PV stenosis, and thus the ratio of post-operative PV stenosis in patients with PV resection following NACRT is 37.5% in this series. We encountered no case of PV stenosis among 22 patients operated with PV resection for pancreatobiliary cancer without NACRT during the same period. A relationship between PV stenosis and NACRT is suspected, but further investigation is required to determine whether NACRT has relevance to PV stenosis.

• Pancreatic cancer
• Portal vein stenosis
• Neoadjuvant chemoradiation therapy
• Pancreatectomy
• Expandable metallic stent

• Adult
• Aged
• Chemotherapy, Adjuvant/adverse effects
• Constriction, Pathologic
• Female
• Humans
• Male
• Middle Aged
• Neoadjuvant Therapy/adverse effects
• Pancreatectomy/adverse effects
• Pancreatic Neoplasms/diagnostic imaging
• Pancreatic Neoplasms/therapy
• Portal Vein/diagnostic imaging
• Portal Vein/surgery
• Portography
• Stents
• Tomography, X-Ray Computed
• Treatment Outcome
• Vascular Diseases/diagnostic imaging
• Vascular Diseases/etiology
• Vascular Diseases/therapy

• hepatobiliary pancreatic malignant tumour
• portal vein occlusion
• portal venous stent
• stenosis