Korean J Radiol.  2005 Sep;6(3):161-166. 10.3348/kjr.2005.6.3.161.

Percutaneous Angioplasty of Portal Vein Stenosis that Complicates Liver Transplantation: The Mid-Term Therapeutic Results

• Park KB
• Choo SW
• Do YS
• Shin SW
• Cho SG
• Choo IW

• KMID: 1102712
• DOI: http://doi.org/10.3348/kjr.2005.6.3.161

Abstract

OBJECTIVE
We wanted to valuate the mid-term therapeutic results of percutaneous transhepatic balloon angioplasty for portal vein stenosis after liver transplantation. MATERIALS AND METHODS: From May 1996 to Feb 2005, 420 patients underwent liver transplantation. Percutaneous transhepatic angioplasty of the portal vein was attempted in six patients. The patients presented with the clinical signs and symptoms of portal venous hypertension or they were identified by surveillance doppler ultrasonography. The preangioplasty and postangioplasty pressure gradients were recorded. The therapeutic results were monitored by the follow up of the clinical symptoms, the laboratory values, CT and ultrasonography. RESULTS: The overall technical success rate was 100%. The clinical success rate was 83% (5/6). A total of eight sessions of balloon angioplasty were performed in six patients. The mean pressure gradient decreased from 14.5 mmHg to 2.8 mmHg before and after treatment, respectively. The follow up periods ranged from three months to 64 months (mean period; 32 months). Portal venous patency was maintained in all six patients until the final follow up. Combined hepatic venous stenosis was seen in one patient who was treated with stent placement. One patient showed puncture tract bleeding, and this patient was treated with coil embolization of the right portal puncture tract via the left transhepatic portal venous approach. CONCLUSION: Percutaneous transhepatic balloon angioplasty is an effective treatment for the portal vein stenosis that occurs after liver transplantation, and our results showed good mid-term patency with using this technique.

Keyword

Portal vein; Portal vein, stenosis or obstruction; Angioplasty; Interventional procedure; Liver, transplantation

MeSH Terms

Vascular Patency
Ultrasonography, Doppler
Treatment Outcome
Tomography, X-Ray Computed
Postoperative Complications
Portal Vein/*pathology/ultrasonography
Middle Aged
Male
*Liver Transplantation
Infant
Humans
Follow-Up Studies
Female
Constriction, Pathologic
Child
*Angioplasty, Balloon
Adult

Figure

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  Fig. 1 A 33-year-old male patient showed main portal vein stenosis after 31 months from liver transplantation. A. The large thrombus (arrow) is seen in the prestenotic main portal vein. B. Portal venoplasty was performed via the full dilatation of an 18 mm balloon. The transstenotic pressure gradient was 4 mmHg. C. Postangioplasty venogram shows residual stenosis of up to 50%. Residual thrombus in the main portal vein (blank arrow) appears as a filling defect. Collateral venous engorgement is still seen (curved arrow). D. Dual balloon angioplasty was performed up to a 24 mm diameter (with two 12 mm balloons). E. Final portal venogram showed marked decrease of the collateral vein backflow and the widened main portal vein lumen. Thrombus is not seen in the main portal vein. The transstenotic pressure gradient decreased to 0 mmHg.

• 

  Fig. 2 A 33-year-old male patient developed portal vein stenosis 2 months after living related liver transplantation. A. The portal vein shows a severe focal tight stenosis (curved arrow). Note the venous backflow (blank arrow). B. A 16 mm balloon angioplasty was performed. C. The immediate portal venogram shows good main portal vein flow without significant residual stenosis. The venous backflow has disappeared. The transstenotic pressure gradient was decreased from 26 mmHg to 3 mmHg. D. The 8 month follow up CT shows a widely patent lumen of the main portal vein.

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