From the Department of Radiology, Baskent University Ankara Hospital, Ankara, Turkey.
Exp Clin Transplant. 2024 Jan;22(Suppl 1):83-87. doi: 10.6002/ect.MESOT2023.O9.
Portal vein stenosis is a relatively rare complication after liver transplant but has severe consequences. We evaluated the efficacy and longterm results of the endovascular treatment methods for portal vein stenosis.
From October 2011 to October 2022, we treated 22 patients (5 female, 17 male) with portal vein stenosis using endovascular methods. Doppler ultrasonography was used for initial diagnosis, with consideration of flow rate increase over stenosis, absence of flow, or reduced anastomotic segment size (>50%). Angiography served as the gold standard, with a pressure gradient above 5 mm Hg indicating the need for treatment. Technical success criteria were defined as <50% stenosis remaining and/or a pressure gradient <5mm Hg. The transhepatic approach was used for all patients. Balloon angioplasty was initially performed, and stents were reserved for patients in the early postoperative period or those unresponsive to balloon angioplasty.
The technical success rate was 100%. Mean age was 27.1 years (SD 22.4; range, 4 months to 63 years). Mean time from transplant to intervention was 317 days (range, 0-3135 days). Angioplasty was successful for 7 patients (13.8%). Of 15 patients who underwent stent placement, 9 (40.9%) were in the early postoperative period; in the other 6 patients (27%), results of angioplasty were not satisfactory, and stents were placed. Within 3 months of transplant, 3 patients died because of other complications. Among patients with stents, 2 required reintervention, resulting in reestablishment of good portal venous flow. During the mean follow-up of 24 months (range, 15 days to 9 years), 19 patients (86%) had portal flows within reference limits.
The endovascular approach is a safe and effective treatment option for management of portal vein stenosis in both adult and pediatric liver transplant recipients in the early or late period.
门静脉狭窄是肝移植后相对罕见的并发症，但后果严重。我们评估了血管内治疗门静脉狭窄的疗效和长期结果。
自 2011 年 10 月至 2022 年 10 月，我们采用血管内方法治疗 22 例门静脉狭窄患者（5 例女性，17 例男性）。多普勒超声用于初步诊断，考虑狭窄处血流增加、无血流或吻合口节段缩小（>50%）。血管造影作为金标准，压力梯度>5mmHg 提示需要治疗。技术成功标准定义为狭窄<50%残留和/或压力梯度<5mmHg。所有患者均采用经肝途径。最初行球囊血管成形术，如果对球囊血管成形术无反应或术后早期患者保留支架。
技术成功率为 100%。平均年龄为 27.1 岁（标准差 22.4；范围 4 个月至 63 岁）。从移植到干预的平均时间为 317 天（范围 0-3135 天）。血管成形术成功 7 例（13.8%）。15 例患者行支架置入术，其中 9 例（40.9%）为术后早期；另外 6 例（27%）血管成形术效果不理想，放置支架。在移植后 3 个月内，3 例患者因其他并发症死亡。在支架患者中，2 例需要再次介入治疗，从而重新建立良好的门静脉血流。在平均 24 个月（范围 15 天至 9 年）的随访期间，19 例患者（86%）的门静脉血流处于参考范围内。
血管内方法是成人和儿童肝移植受者早期或晚期门静脉狭窄的安全有效治疗选择。
