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CardioVascular and Interventional Radiology

, Volume 30, Issue 4, pp 688–695 | Cite as

Interventional Radiological Management of Prehepatic Obstruction the Splanchnic Venous System

  • Aslihan Semiz-OysuEmail author
  • Inger Keussen
  • Wojciech Cwikiel
Clinical Investigation

Abstract

Purpose

The purpose of this study was to retrospectively evaluate interventional radiological management of patients with symptomatic portal hypertension secondary to obstruction of splanchnic veins.

Material and Methods

Twenty-four patients, 15 males and 9 females, 0.75 to 79 years old (mean, 36.4 years), with symptomatic portal hypertension, secondary to splanchnic venous obstruction, were treated by percutaneous methods. Causes and extent of splanchnic venous obstruction and methods are summarized following a retrospective evaluation.

Results

Obstructions were localized to the main portal vein (n = 22), intrahepatic portal veins (n = 8), splenic vein (n = 4), and/or mesenteric veins (n = 4). Interventional treatment of 22 (92%) patients included recanalization (n = 19), pharmacological thrombolysis (n = 1), and mechanical thrombectomy (n = 5). Partial embolization of the spleen was done in five patients, in two of them as the only possible treatment. TIPS placement was necessary in 10 patients, while an existing occluded TIPS was revised in two patients. Transhepatic embolization of varices was performed in one patient, and transfemoral embolization of splenorenal shunt was performed in another. Thirty-day mortality was 13.6% (n=3). During the follow-up, ranging between 2 days and 58 months, revision was necessary in five patients. An immediate improvement of presenting symptoms was achieved in 20 patients (83%).

Conclusion

We conclude that interventional procedures can be successfully performed in the majority of patients with obstruction of splanchnic veins, with subsequent improvement of symptoms. Treatment should be customized according to the site and nature of obstruction.

Keywords

Portal vein Splanchnic veins Thrombosis Occlusion Recanalization TIPS Portal hypertension Gastroesophageal varices Bleeding 

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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Aslihan Semiz-Oysu
    • 1
    • 2
    Email author
  • Inger Keussen
    • 3
  • Wojciech Cwikiel
    • 4
  1. 1.Department of RadiologySiyami Ersek Thoracic and Cardiovascular Surgery Training and Research CenterIstanbulTurkey
  2. 2.Siyami Ersek Gogus Kalp ve Damar Cerrahisi Egitim ve Arastirma HastanesiIstanbulTurkey
  3. 3.Department of RadiologyMalmoe University HospitalMalmoeSweden
  4. 4.Department of RadiologyUniversity of Michigan HospitalAnn ArborUSA

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