Department of Radiology, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan.
Acta Radiol. 2024 Sep;65(9):1046-1051. doi: 10.1177/02841851241273938. Epub 2024 Aug 28.
Bleeding from the puncture tract after percutaneous transhepatic portal vein intervention can become life-threatening. To date, studies about tract embolization with gelatin sponge after percutaneous transhepatic portal vein intervention are only with small numbers of patients, or non-consecutive or pediatric patients with a relatively small sheath in diameter.
To evaluate the safety and efficacy of tract embolization with gelatin sponge strips after percutaneous transhepatic poral vein access.
Between September 2017 and February 2024, 100 consecutive patients (61 men, 39 women; mean age = 53 ± 15 years) underwent a total of 105 portal vein interventions using a percutaneous transhepatic approach. Tract embolization for the removal of 6-8 Fr sheath was performed using gelatin sponge strips in all procedures, including 71 portal vein embolization before major hepatectomy, 27 portal balloon venoplasty or stent placement after liver transplantation, and seven other interventions.
No bleeding occurred after tract embolization with gelatin sponge strips. Minor portal vein thrombosis was detected in three procedures after liver transplantation and in one procedure for portal vein stenosis caused by essential thrombocytopenia. Thrombosis occurred in the punctured portal vein branch in all procedures. Thrombosis was not clinically relevant in any patient, and it was difficult to differentiate whether thrombosis was caused by sheath placement or the inserted gelatin sponge.
Tract embolization with gelatin sponge strips after percutaneous transhepatic portal vein intervention is a safe and feasible method for preventing hemorrhage from the puncture tract.
经皮经肝门静脉介入后穿刺道出血可能危及生命。迄今为止，关于经皮经肝门静脉介入后使用明胶海绵进行窦道栓塞的研究仅涉及少数患者，或者是非连续或儿科患者，其鞘径相对较小。
评估经皮经肝门静脉入路后使用明胶海绵条进行窦道栓塞的安全性和有效性。
2017 年 9 月至 2024 年 2 月，100 例连续患者（61 例男性，39 例女性；平均年龄=53±15 岁）共进行了 105 次经皮经肝门静脉介入。所有操作均使用明胶海绵条进行窦道栓塞以取出 6-8Fr 鞘，包括 71 例用于肝切除术的门静脉栓塞术，27 例肝移植后的门静脉球囊血管成形术或支架置入术，以及其他 7 例介入操作。
经皮经肝门静脉介入后使用明胶海绵条进行窦道栓塞后无出血发生。肝移植后 3 例和特发性血小板增多症引起的门静脉狭窄 1 例发生轻微门静脉血栓形成。所有操作均出现穿刺门静脉分支血栓形成。在任何患者中，血栓均无临床意义，难以区分血栓是由鞘放置还是插入的明胶海绵引起的。
经皮经肝门静脉介入后使用明胶海绵条进行窦道栓塞是预防穿刺道出血的一种安全且可行的方法。
