Percutaneous recanalization of non-cirrhotic extrahepatic portal vein obstruction in children: technical considerations in a preliminary cohort.

Extrahepatic portal vein obstruction Meso-Rex bypass Portal hypertension Portal vein recanalization Portal vein thrombosis

Journal

European radiology
ISSN: 1432-1084
Titre abrégé: Eur Radiol
Pays: Germany
ID NLM: 9114774

Informations de publication

Date de publication:
06 Sep 2024
Historique:
received: 17 03 2024
accepted: 07 08 2024
revised: 29 07 2024
medline: 7 9 2024
pubmed: 7 9 2024
entrez: 6 9 2024
Statut: aheadofprint

Résumé

Portal hypertension resulting from non-cirrhotic extrahepatic portal vein obstruction (EHPVO) in children has been primarily managed with the Meso-Rex bypass, but only a few patients have a viable Rex recessus, required by surgery. This study reports a preliminary series of patients who underwent interventional radiology attempts at portal vein recanalization (PVR), with a focus on technical aspects and safety. A retrospective review of consecutive patients with severe portal hypertension due to non-cirrhotic EHPVO at a single institution from 2022, who underwent percutaneous attempts at PVR, was performed. Technical and clinical data including fluoroscopy time, radiation exposure, technical and clinical success, complications and follow-up were recorded. Eleven patients (6 males and 5 females; median age 7 years, range 1-14) underwent 15 percutaneous transhepatic (n = 1), transplenic (n = 11), or simultaneous transhepatic/transplenic (n = 3) procedures. Rex recessus was patent in 4/11 (36%). Fluoroscopy resulted in a high median total dose area product (DAP) of 123 Gycm Our preliminary experience suggests that 45% of children with non-cirrhotic EHPVO can restore portal flow even with obliterated Rex recessus. In non-cirrhotic EHPVO, PVR may be an option, if a Meso-Rex bypass is not feasible, although the radiation exposure deserves attention. Innovative percutaneous procedures may have the potential to be an alternative option to the traditional surgical approach in the management of non-cirrhotic EHPVO and its complications in children not eligible for Meso-Rex bypass surgery. Non-cirrhotic portal hypertension in children has been traditionally managed by surgery with Meso-Rex bypass creation. Percutaneous PVR may restore the patency of the native portal system even when the Rex recessus is obliterated and surgery has been excluded. Interventional radiological techniques may offer a minimally invasive solution in complex cases of EHPVO in children when Meso-Rex bypass is not feasible.

Identifiants

DOI: 10.1007/s00330-024-11040-8 PMID: 39242398
pubmed: 39242398
doi: 10.1007/s00330-024-11040-8
pii: 10.1007/s00330-024-11040-8
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. The Author(s).

Références

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Auteurs

Paolo Marra (P)

Department of Radiology, ASST Papa Giovanni XXIII Hospital, School of Medicine and Surgery, University of Milano Bicocca, Bergamo, Italy. pmarra@asst-pg23.it.
ORCID: 0000-0003-4935-8110

Stephanie Franchi-Abella (S)

Department of Pediatric Radiology, DMU Smart Imaging, Bicêtre Hospital, AP-HP. Reference Centre for Vascular Diseases of the Liver, FSMR FILFOIE, ERN RARE LIVER, FHU Hépatinov, Le Kremlin-Bicêtre, France.
BIOMAPS UMR 9011 CNRS-INSERM-CEA, Paris-Saclay University, Paris, France.

José A Hernandez (JA)

Department of Interventional Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
Department of Radiology, Baylor College of Medicine, Houston, TX, USA.

Maxime Ronot (M)

Service de Radiologie, Hôpital Beaujon APHP Nord, Clichy & Université Paris Cité, CRI, INSERM, Paris, France.

Riccardo Muglia (R)

Department of Radiology, ASST Papa Giovanni XXIII Hospital, School of Medicine and Surgery, University of Milano Bicocca, Bergamo, Italy.

Lorenzo D'Antiga (L)

Pediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.
Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.

Sandro Sironi (S)

Department of Radiology, ASST Papa Giovanni XXIII Hospital, School of Medicine and Surgery, University of Milano Bicocca, Bergamo, Italy.
Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.

Classifications MeSH