Portal Vein Angioplasty/Stenting in the Treatment of Portal Vein Stenosis

Tuesday, March 7, 2023

4:12 PM – 4:21 PM

Location: Phoenix Convention Center, 226ABC

Presenting Author(s)

Bassam Theodory, BS

Medical Student
University of California, Riverside School of Medicine

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

MR

Michael Repajic, BA

Medical Student
Keck School of Medicine of USC
BD

Brittney Deadwiler, BA

Medical Student
Keck School of Medicine of USC
NB

Neelesh Bagrodia, BS

Medical Student
Keck School of Medicine of USC
Jesse Han, BA (he/him/his)

Medical Student
Keck School of Medicine of USC
NZ

Naveed Zaman, BS

Medical Student
Keck School of Medicine of USC
MK

Michael Katz, MD

Interventional Radiologist
Keck School of Medicine of USC
RT

Ramon Ter-Oganesyan, MD

Interventional Radiologist
University of Southern California
SS

Stuart Schroff, MD

Interventional Radiologist
Keck School of Medicine of USC
JV

Jenanan Vairavamurthy, MD

Assistant Professor, Interventional Radiologist
Keck School of Medicine, Univeristy of Southern California

Disclosure(s):

Bassam Theodory, BS: No financial relationships to disclose

Jesse Han, BA: No financial relationships to disclose

Purpose: Portal vein stenosis and/or thrombosis can occur in the setting of liver transplantation, partial hepatectomy, other surgical procedures, and malignant or inflammatory conditions. In this study, we aimed to determine the efficacy of angioplasty and stent placement in treatment of portal vein stenosis at a single-center.

Materials and Methods: A retrospective review of portal vein angioplasty/stent procedures was performed. Inclusion criteria were patients with portal vein stenosis or thrombosis secondary to a surgical procedure or malignant/inflammatory process. In total, 29 patients who fit study criteria were identified over a 15 year period. In total, 34 angioplasty procedures were performed, including 26 stent placements. Portal vein patency and patency rates were evaluated at 1, 3, 6, and 12 month intervals. Primary patency was defined as the time from initial intervention to last imaging demonstrating patency. Assisted primary patency, and secondary patency, were defined as the time from subsequent intervention to last imaging demonstrating patency in patients that required repeat intervention for subsequent narrowing, or for thrombosis/occlusion, respectively.

Results:
Of the cohort, 24 (83%) only required one intervention. Of these 24, 15 had imaging follow up at 1 month, 13 at 3 months, 12 at 6 months, and 7 at 12 months. At 1, 6, and 12 months, 100% primary patency was seen. At 3 months, 92% primary patency was seen, as one patient developed a thrombus. Five (17%) patients required repeat intervention for narrowing/stenosis with two (7%) experiencing occlusion/thrombosis. For the three that experienced narrowing/stenosis, a 100% 6-month assisted primary patency rate was seen. Two of these patients also had imaging beyond 1 year demonstrating patency. For the 2 that experienced occlusion/thrombosis, both had 1 month imaging to demonstrate a 100% 1 month secondary patency rate. Only one patient had follow up to 12 months to demonstrate patency. Five patients had ascites, with four (80%) experiencing resolution. Fourteen patients had elevated liver enzymes, with 10 (71%) experiencing an improvement. Five patients died, with an average time of 11.2 months from time of intervention to death, due to progression of malignancy and liver transplant rejection.

Conclusion: Based on patency data, improvement in ascites, and reduction in liver enzymes, angioplasty/stent placement are effective interventions in this setting. With a larger patient cohort and adequate follow up, future analysis may assist in classifying the efficacy of angioplasty/stent placement in this setting.