Journals Information
Universal Journal of Medical Science(CEASE PUBLICATION) Vol. 4(2), pp. 45 - 64
DOI: 10.13189/ujmsj.2016.040201
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Percutaneous Management of Portal Vein Patency and Integrity Problems - Catheter Directed Local Thrombolysis, Stenting, Endoluminal RFA & Angioplasty by Balloon or Stenting
M. Mizandari 1,*, N. Habib 2
1 High Technology Medical Center - University Clinic, Georgia
2 Department of Biosurgery & Surgical Technology, Faculty of Surgery, Oncology, Reproductive Biology & Anaesthetics, Imperial College, UK
ABSTRACT
Purpose: Spectrum of PV patency and integrity percutaneous restoration techniques is presented. Material and methods: Total twenty patients with portal hypertension due to PV patency & integrity problem; among them percutaneous recanalization was attempted in fifteen patients with PV tumor thrombus using a novel endoluminal bipolar radiofrequency device. The procedure was completed in twelve of fifteen RFA cases; RFA was followed by balloon angioplasty (six cases) or vascular stent placement (six cases). In two cases catheter directed local thrombolysis was performed to acutely manifest fresh PV thrombosis, caused by thrombophylia and HCC. In two cases of pancreatitis induced PV thrombosis & stricture and one case of pancreatitis induced PV thrombosis & stricture and porto-biliary fistula, PV stenting was performed. The PV tributary was percutaneously accessed under US guidance and 5G guide catheter was manipulated through the obstruction using guidewire technique under DSA guidance. In case of thrombolysis thrombolytic agent was injected directly distal to the thrombus, the stenting procedure was completed by self-expanding vascular stent placement. Results: The technical success rate was 85.0%; in three cases (15.0%) wire conduction through the organized thrombus was impossible. Posprocedure portography documented significantly improved portal vein blood flow in all patients, to whom the procedure was completed. Porto-biliary fistula was successfully managed by percutaneous stenting. In three cases postprocedure bleeding was documented, which led to multiorgan failure and death in one case. Conclusions: The management of PV patency and integrity problems by percutaneous stenting or endoluminal RFA and stenting is an effective technique; it should be suggested as a treatment option for otherwise incurable patients and might be used as a bridge for further treatment. Post-procedure intraperitoneal bleeding is a possible life-threatening complication which should be prevented by procedure track ablation or embolization.
KEYWORDS
Portal Vein, Thrombosis, Recanalization, Endoluminal RFA, Stenting
Cite This Paper in IEEE or APA Citation Styles
(a). IEEE Format:
[1] M. Mizandari , N. Habib , "Percutaneous Management of Portal Vein Patency and Integrity Problems - Catheter Directed Local Thrombolysis, Stenting, Endoluminal RFA & Angioplasty by Balloon or Stenting," Universal Journal of Medical Science(CEASE PUBLICATION), Vol. 4, No. 2, pp. 45 - 64, 2016. DOI: 10.13189/ujmsj.2016.040201.
(b). APA Format:
M. Mizandari , N. Habib (2016). Percutaneous Management of Portal Vein Patency and Integrity Problems - Catheter Directed Local Thrombolysis, Stenting, Endoluminal RFA & Angioplasty by Balloon or Stenting. Universal Journal of Medical Science(CEASE PUBLICATION), 4(2), 45 - 64. DOI: 10.13189/ujmsj.2016.040201.