Skip to main content

Advertisement

SpringerLink
Log in

Interventional Radiological Management of Prehepatic Obstruction the Splanchnic Venous System

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

An Erratum to this article was published on 18 October 2007

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Valla DC, Condat B (2000) Portal vein thrombosis in adults: pathophysiology, pathogenesis and management. J Hepatol 32:865–871

    Article  PubMed  CAS  Google Scholar 

  2. Mathias K, Bolder U, Lohlein D, et al. (1993) Percutaneous transhepatic angioplasty and stent implantation for prehepatic portal vein obstruction. Cardiovasc Intervent Radiol 16:313–315

    Article  PubMed  CAS  Google Scholar 

  3. Janssen HL, Wijnhoud A, Haagsma EB, et al. (2001) Extrahepatic portal vein thrombosis: aetiology and determinants of survival. Gut 49:720–724

    Article  PubMed  CAS  Google Scholar 

  4. Hidajat N, Stobbe H, Griesshaber V, et al. (2005) Imaging and radiological interventions of portal vein thrombosis. Acta Radiol 46:336–343

    Article  PubMed  CAS  Google Scholar 

  5. Cwikiel W, Keussen I, Larsson L, et al. (2003) Interventional treatment of children with portal hypertension secondary to portal vein occlusion. Eur J Pediatr Surg 13:312–318

    Article  PubMed  CAS  Google Scholar 

  6. Cwikiel W (2006) Interventional procedures involving portal vein circulation: a review. Acta Radiol 47:145–156

    Article  PubMed  CAS  Google Scholar 

  7. Kawamata H, Kumazaki T, Kanazawa H, et al. (2000) Transjugular intrahepatic portosystemic shunt in a patient with cavernomatous portal vein occlusion. Cardiovasc Interv Radiol 23:145–149

    Article  CAS  Google Scholar 

  8. Mosimann F, Berger D, Cuenoud PF, et al. (1990) Portal vein thrombosis of the adolescent: indications for autologous internal jugular vein interposition meso-caval shunt. Z Kinderchir 45:189–191

    PubMed  CAS  Google Scholar 

  9. Radosevich PM, Ring EJ, LaBerge JM, et al. (1993) Transjugular intrahepatic portosystemic shunts in patients with portal vein occlusion. Radiology 186:523–527

    PubMed  CAS  Google Scholar 

  10. Matsui O, Yoshikawa J, Kadoya M, et al. (1996) Transjugular intrahepatic portosystemic shunt after previous recanalization of a chronically thrombosed portal vein via a transmesenteric approach. Cardiovasc Interv Radiol 19:352–355

    CAS  Google Scholar 

  11. Dasgupta R, Roberts E, Superina RA, et al. (2006) Effectiveness of Rex shunt in the treatment of portal hypertension. J Pediatr Surg 41:108–112

    Article  PubMed  Google Scholar 

  12. Kuran S, Oguz D, Parlak E, et al. (2006) Secondary prophylaxis of esophageal variceal treatment: endoscopic sclerotherapy, band ligation and combined therapy—long-term results. Turk J Gastroenterol 17:103–109

    PubMed  Google Scholar 

  13. Vogelzang RL, Reddy SG, Braun MA, et al. (1996) Extrahepatic portal venous stenosis: treatment with percutaneous transhepatic stent placement. J Vasc Interv Radiol 7:269–271

    PubMed  CAS  Google Scholar 

  14. Citron SJ, Brantley SD (1998) TIPS in portal vein occlusions: facilitation with percutaneous splenic access. J Vasc Interv Radiol 9:363–364

    Article  PubMed  CAS  Google Scholar 

  15. Shimizu T, Onda M, Tajiri T, et al. (2002) Bleeding portal-hypertensive gastropathy managed successfully by partial splenic embolization. Hepatogastroenterology 49:947–949

    PubMed  Google Scholar 

  16. Vargas JH. (1994) Splenic embolization for portal hypertension in children. J Pediatr 125:505–506

    PubMed  CAS  Google Scholar 

  17. Israel DM, Hassall E, Culham JA, et al. (1994) Partial splenic embolization in children with hypersplenism. J Pediatr 124:95–100

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Center, Istanbul, Turkey

    Aslihan Semiz-Oysu

  2. Siyami Ersek Gogus Kalp ve Damar Cerrahisi Egitim ve Arastirma Hastanesi, Radyoloji Bolumu, Tibbiye Caddesi, Haydarpasa, Istanbul, Turkey

    Aslihan Semiz-Oysu

  3. Department of Radiology, Malmoe University Hospital, Malmoe, Sweden

    Inger Keussen

  4. Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, 48109, USA

    Wojciech Cwikiel

Authors
  1. Aslihan Semiz-Oysu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Inger Keussen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wojciech Cwikiel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aslihan Semiz-Oysu.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00270-007-9182-7

Rights and permissions

Reprints and permissions

About this article

Cite this article

Semiz-Oysu, A., Keussen, I. & Cwikiel, W. Interventional Radiological Management of Prehepatic Obstruction the Splanchnic Venous System. Cardiovasc Intervent Radiol 30, 688–695 (2007). https://doi.org/10.1007/s00270-007-9097-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-007-9097-3

Keywords

Search

Navigation