Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea; Seoul National University College of Medicine, Seoul, Korea.
Eur J Radiol. 2022 Apr;149:110230. doi: 10.1016/j.ejrad.2022.110230. Epub 2022 Feb 26.
To evaluate the long-term efficacy of transhepatic stentplacement in patients with symptomatic malignant portal vein(PV) obstruction and to identify risk factors for stent failure.
From April 2011 to March 2021, transhepatic stent placement was attempted in 36 patients with symptomatic malignant PV obstruction: naïve (n = 20) or recurrent tumor after surgery (n = 16). Technical success, clinical outcomes, and complications were retrospectively evaluated. Thirteen relevant variables were analyzed to determine risk factors for stent failure.
Stent was successfully placed in all but one patient (97.2%, 35/36). Thromboaspiration (n = 9) and jejunal variceal embolization (n = 4) were performed in same session. Symptoms related to portal hypertension were resolved in 30 of the 35 patients (85.7%). There was no procedure-related major complication. During the follow-up period (median 175 days),stentfailures occurred in 8 patients (22.9%): 7 stent thromboses within 90 days and one tumor ingrowth at 715 days after stent placement. The 1-, 6-, 12-month stent patency was 94.1%, 78.2%, and 62.6%, respectively. In multivariate analysis, the presence of PV thrombosisat the time of stent placement was associated with stent failure (HR 7.22; 95% CI 1.26-41.29, p = 0.03).
Transhepatic stentplacement is a safe and effective treatment for malignant PV obstruction. However, stent failure was common (22.9%) and mostly due to early stent thrombosis. The stent failure was associated with PV thrombosis at the time of stent placement.
评估经肝支架置入术治疗有症状的恶性门静脉（PV）阻塞患者的长期疗效，并确定支架失败的危险因素。
回顾性分析 2011 年 4 月至 2021 年 3 月间 36 例有症状的恶性 PV 阻塞患者（初治 20 例，术后复发 16 例）行经肝支架置入术的资料。评估技术成功率、临床疗效和并发症。分析 13 个相关变量以确定支架失败的危险因素。
除 1 例患者（97.2%，35/36）外，其余患者均成功置入支架。在同一治疗周期内，9 例行血栓抽吸术，4 例行空肠曲张静脉栓塞术。35 例患者中 30 例（85.7%）的门静脉高压相关症状得到缓解。无与操作相关的严重并发症。在随访期间（中位时间 175 天），8 例（22.9%）患者发生支架失败：7 例支架内血栓形成发生于 90 天内，1 例肿瘤生长发生于支架置入后 715 天。1、6、12 个月的支架通畅率分别为 94.1%、78.2%和 62.6%。多因素分析显示，支架置入时存在 PV 血栓与支架失败相关（HR 7.22；95%CI 1.26-41.29，p=0.03）。
经肝支架置入术治疗恶性 PV 阻塞是一种安全有效的治疗方法。然而，支架失败较为常见（22.9%），主要原因是早期支架内血栓形成。支架失败与支架置入时存在 PV 血栓相关。
