Portal vein recanalisation alone to treat severe portal hypertension in non-cirrhotic patients with chronic extrahepatic portal vein obstruction.
CNC-EHPVO, chronic noncirrhotic extrahepatic portal vein obstruction
Chronic non-cirrhotic extrahepatic portal vein obstruction (CNC-EHPVO)
DICOM, digital imaging and communications in medicine
EHPVO, extrahepatic portal vein obstruction
Gastrointestinal bleeding
HE, hepatic encephalopathy
L3, lumbar 3
L3SMI, skeletal muscle index at L3
L4, lumbar 4
NFH, non-fractioned heparin
PVR, portal vein recanalisation
Portal cholangiopathy
Portal hypertension
Portal vein recanalisation
SMI, skeletal muscle index
SMV, superior mesenteric vein
SV, splenic vein
Sarcopenia
TIPS, transjugular intrahepatic portosystemic shunt
TPMA, total psoas muscle area
US, ultrasound
Journal
JHEP reports : innovation in hepatology
ISSN: 2589-5559
Titre abrégé: JHEP Rep
Pays: Netherlands
ID NLM: 101761237
Informations de publication
Date de publication:
Aug 2022
Aug 2022
Historique:
received:
14
10
2021
revised:
26
04
2022
accepted:
04
05
2022
entrez:
8
7
2022
pubmed:
9
7
2022
medline:
9
7
2022
Statut:
epublish
Résumé
We aimed to evaluate long-term outcome of patients with chronic non-cirrhotic extrahepatic portal vein obstruction (CNC-EHPVO) who underwent portal vein recanalisation (PVR) without transjugular intrahepatic portosystemic shunt (TIPS) insertion and to determine factors predicting PVR failure and stent occlusion. This retrospective monocentric study included all patients who underwent PVR without TIPS insertion in the context of CNC-EHPVO between the years 2000 and 2019. Primary patency was defined by the absence of a complete stent occlusion on follow-up imaging. A total of 31 patients underwent PVR with a median follow-up of 52 months (24-82 months). Indications were gastrointestinal bleeding (n = 13), abdominal pain attributed to CNC-EHPVO (n = 7), prior to abdominal surgery (n = 4), and others (n = 7). Technical success was obtained in 27 patients. PVR failure was associated with extension within the intrahepatic portal veins ( PVR without TIPS insertion was feasible and safe in selected patients with CNC-EHPVO and portal hypertension with past or expected complications. Primary patency at 5 years was obtained in 3 of 4 patients with technical success of PVR and was associated with a control of complications of CNC-EHPVO. PVR was associated with improvement of sarcopenia and decreased spleen volume at 1 year. Patients with chronic obstruction of the portal vein and without cirrhosis or malignancy can develop complications related to the high pressure in the venous system. The present study reports long-term favourable outcome of patients in whom the obstruction was treated with stents.
Sections du résumé
Background & Aims
UNASSIGNED
We aimed to evaluate long-term outcome of patients with chronic non-cirrhotic extrahepatic portal vein obstruction (CNC-EHPVO) who underwent portal vein recanalisation (PVR) without transjugular intrahepatic portosystemic shunt (TIPS) insertion and to determine factors predicting PVR failure and stent occlusion.
Methods
UNASSIGNED
This retrospective monocentric study included all patients who underwent PVR without TIPS insertion in the context of CNC-EHPVO between the years 2000 and 2019. Primary patency was defined by the absence of a complete stent occlusion on follow-up imaging.
Results
UNASSIGNED
A total of 31 patients underwent PVR with a median follow-up of 52 months (24-82 months). Indications were gastrointestinal bleeding (n = 13), abdominal pain attributed to CNC-EHPVO (n = 7), prior to abdominal surgery (n = 4), and others (n = 7). Technical success was obtained in 27 patients. PVR failure was associated with extension within the intrahepatic portal veins (
Conclusions
UNASSIGNED
PVR without TIPS insertion was feasible and safe in selected patients with CNC-EHPVO and portal hypertension with past or expected complications. Primary patency at 5 years was obtained in 3 of 4 patients with technical success of PVR and was associated with a control of complications of CNC-EHPVO. PVR was associated with improvement of sarcopenia and decreased spleen volume at 1 year.
Lay summary
UNASSIGNED
Patients with chronic obstruction of the portal vein and without cirrhosis or malignancy can develop complications related to the high pressure in the venous system. The present study reports long-term favourable outcome of patients in whom the obstruction was treated with stents.
Identifiants
pubmed: 35801087
doi: 10.1016/j.jhepr.2022.100511
pii: S2589-5559(22)00083-0
pmc: PMC9253474
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100511Informations de copyright
© 2022 The Author(s).
Déclaration de conflit d'intérêts
None of the contributing authors have disclosures related to this work. Please refer to the accompanying ICMJE disclosure forms for further details.
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