Angioplasty treatment of portal vein stenosis in children with segmental liver transplants: Mid-term results
Angioplasty treatment of portal vein stenosis in children with segmental liver transplants: Mid-term results
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DOI：
10.2214/ajr.169.2.9242775
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发表时间：
1997-08-01
影响因子：
5
通讯作者：
Alonso, EM
中科院分区：
文献类型：
--
作者：
Funaki, B;Rosenblum, JD;Alonso, EM
OBJECTIVE.经皮静脉成形术在治疗儿童减体积肝移植门静脉狭窄方面显示了良好的技术成功率和良好的早期效果。我们回顾了22例儿童门静脉成形术的中期结果。在27个月期间，对22例门静脉狭窄患儿进行了经皮经皮经鞘门静脉成形术。患者出现门静脉高压症状或通过移植后多普勒超声常规监测确定。所有狭窄均经血管造影证实。在狭窄段球囊血管成形术之前，通过直接穿刺肝内门静脉进行静脉成形术。患者随访超声监测，并根据需要进行再干预。对于门静脉成形术后效果欠佳或出现复发性狭窄的患者，应在狭窄处放置血管内支架。22例患者中有16例获得了初步临床和技术成功。在6例手术失败的患者中，门静脉完全闭塞，无法进入肝外门静脉。在16名成功接受手术的患者中，5名患者在初始静脉成形术时放置血管内支架治疗弹性狭窄。在其他7例患者中，门静脉成形术后发生再狭窄（平均6.3个月），需要血管内支架置入。4例成功接受静脉成形术而未置入支架的患者无需进一步干预。所有16例患者均成功完成了4-29个月（平均20个月）的门静脉通畅。对于接受减体积肝移植的儿童，如果出现迟发性门静脉狭窄，经皮经鞘门静脉成形术取得了令人鼓舞的中期结果。它是我们医院的首选手术，通常无需手术翻修、门腔静脉分流或再次移植。
OBJECTIVE. Percutaneous venoplasty has showed excellent technical success and excellent early results in treating portal vein stenoses in children with reduced-size liver transplants. We review the mid-term results in 22 children in whom portal venoplasty was attempted.SUBJECTS AND METHODS. During 27 months, percutaneous transhepatic portal venoplasty was attempted in 22 children with portal vein stenoses. Patients presented with symptoms of portal vein hypertension or were identified by routine surveillance with posttransplantation Doppler sonography. All stenoses were verified with angiography. Venoplasty was performed by direct puncture of an intrahepatic portal vein before balloon angioplasty of the stenotic segment. Patients were followed up with sonographic surveillance, and reintervention was performed as needed. In patients who had suboptimal results after portal venoplasty or who developed recurrent stenoses, intravascular stents were placed across stenoses.RESULTS. In 16 of 22 patients, initial clinical and technical success was achieved. In the six patients who underwent unsuccessful procedures, complete occlusion of the portal vein precluded access to the extrahepatic portal vein. Of the 16 patients who underwent successful procedures, intravascular stents were placed at the time of initial venoplasty in five patients for elastic stenosis. In seven other patients, portal vein restenosis occurred after venoplasty (mean, 6.3 months), necessitating intravascular stent placement. Four patients who underwent successful venoplasty without stent placement have required no further intervention. Portal vein patency has been maintained in all 16 patients who underwent technically successful procedures for 4-29 months (mean, 20 months).CONCLUSION. In children with reduced-size liver transplants who experience delayed portal vein stenosis, percutaneous transhepatic portal venoplasty has achieved encouraging mid-term results. It is the procedure of choice in our hospital and often eliminates the need for surgical revision, portacaval shunting, or retransplantation.