Department of Surgery-Transplantation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Diagn Interv Radiol. 2019 May;25(3):231-237. doi: 10.5152/dir.2019.18155.
It is not easy to determine whether balloon angioplasty or stenting should be performed in patients with portal vein stenosis after liver transplantation. We aimed to propose appropriate indication by evaluating long-term outcomes of balloon angioplasty and stent insertion in adult liver transplant patients.
We retrospectively reviewed 31 patients with portal vein stenosis among 1369 patients who underwent adult liver transplantation from January 2001 to December 2015. When stenosis was confirmed by venography, angioplasty was performed first. When there was no flow improvement or pressure gradient was not decreased after angioplasty, stent insertion was performed. We also performed primary stent insertion without angioplasty for diffuse stenosis, kinking, external compression, and near occlusion of portal vein in venography. We assessed patency in patients who underwent percutaneous transluminal angioplasty and stent insertion through regular outpatient follow-up and evaluated technical and clinical success and long-term results.
Technical success was 85% and 100% in balloon angioplasty and stent insertion, respectively. Clinical success was achieved in 78% of balloon angioplasties and in 100% of stent insertions. At 1, 5, and 10 years after balloon angioplasty, patency rates were 87%, 82%, and 68% respectively, and the rates of stent patency were all 100%. Portal vein size measured during the operation of patients with and without recurrence were 19±4.2 mm and 19±3.0 mm (P = 0.956), respectively. The balloon size of patients with and without recurrence were 11±1.95 mm and 14±1.66 mm, respectively (P = 0.013), when balloon angioplasty was performed after stenosis diagnosis.
Stent insertion can be considered when fibrotic changes are expected due to repeated inflammation and when the balloon size to be used is small. Balloon angioplasty seems less risky for anastomotic ruptures in portal vein stenosis in the early post liver transplantation period.
对于肝移植术后门静脉狭窄患者，选择行球囊血管成形术还是支架置入术并不容易。本研究旨在通过评估成人肝移植患者行球囊血管成形术和支架置入术的长期疗效，提出合适的适应证。
回顾性分析 2001 年 1 月至 2015 年 12 月期间 1369 例行成人肝移植患者中 31 例门静脉狭窄患者的临床资料。血管造影证实狭窄后，首先行球囊血管成形术。如果血管成形术后无血流改善或压力梯度未降低，则行支架置入术。对于弥漫性狭窄、成角、外压和门静脉近段闭塞，我们也在血管造影时行单纯支架置入术而不先行球囊血管成形术。通过定期门诊随访评估经皮腔内血管成形术和支架置入术患者的通畅性，并评估技术和临床成功率及长期结果。
球囊血管成形术和支架置入术的技术成功率分别为 85%和 100%，临床成功率分别为 78%和 100%。球囊血管成形术后 1、5 和 10 年的通畅率分别为 87%、82%和 68%，支架通畅率均为 100%。无复发患者和有复发患者术中门静脉直径分别为 19±4.2mm 和 19±3.0mm（P=0.956），无复发患者和有复发患者球囊直径分别为 11±1.95mm 和 14±1.66mm（P=0.013）。
当预计由于反复炎症而导致纤维化改变，并且预计使用的球囊尺寸较小时，可以考虑支架置入术。对于肝移植术后早期门静脉吻合口破裂的患者，球囊血管成形术似乎风险较低。
