Skip to main content

Advertisement

SpringerLink
Log in

Portal Venous Stent Placement for Malignant Portal Venous Stenosis or Occlusion: Who Benefits?

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

Abstract

Purpose

The purpose of this study was to evaluate the efficacy of portal venous (PV) stent placement and find groups who benefit from this procedure among patients with symptomatic PV hypertension caused by malignant tumors.

Materials and Methods

From October 2001 to January 2013, 13 patients underwent PV stent placement because of PV stenosis or occlusion caused by bile duct cancer (n = 7), pancreatic cancer (n = 5), or nodal metastasis (n = 1). Technical success, changes in PV pressure gradient and palliative prognostic index (PPI) scores before and after stent placement, clinical outcomes, and complications were evaluated.

Result

Stent was successfully placed in all patients (100 %, 13/13), lowering the mean PV pressure gradient from 12.4 ± 4.5 mmHg (range 5–20 mmHg) to 0.5 ± 0.9 mmHg (range 0–3 mmHg, p < 0.000001). Symptoms were improved in all but one patient (92.3 %, 12/13). Although 10 patients (76.9 %, 10/13) with pre-stent placement PPI scores lower than 6 (mean 3.5 ± 1.7, range 0–5) were discharged from the hospital, the other 3 with the pre-stent placement PPI of 6 or more (mean 7.2 ± 1.6, range 6–9.5) died within 4 weeks (range 17–28 days) without discharge. The median survival time of discharged patients was 123 days, and it was 20 days in non-discharged patients (p = 0.0001). A major procedure-related complication of intraperitoneal hemorrhage occurred in one patient (7.7 %, 1/13). No significant factor was detected for the occurrence of complication.

Conclusion

PV stent placement is a feasible, safe, and effective technique to relieve symptomatic PV hypertension caused by malignant tumors. The PPI score might be useful to stratify patients who benefit from this procedure.

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

Similar content being viewed by others

References

  1. Cohen J, Edelman RR, Chopra S. Portal vein thrombosis: a review. Am J Med. 1992;92:173–82.

    Article  CAS  PubMed  Google Scholar 

  2. Macpherson AI. Portal hypertension due to extrahepatic portal venous obstruction: a review of 40 cases. J R Coll Surg Edinb. 1984;29:4–10.

    CAS  PubMed  Google Scholar 

  3. Sarin SK, Agarwal SR. Extrahepatic portal vein obstruction. Semin Liver Dis. 2002;22(1):43–58.

    Article  PubMed  Google Scholar 

  4. Witte CL, Brewer ML, Witte MH, Pond GB. Protean manifestations of pylethrombosis: a review of thirty-four patients. Ann Surg. 1985;202:191–202.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. El Amin H, Abdel Baky L, Sayed Z, et al. A randomized trial of endoscopic variceal ligation versus cyanoacrylate injection for treatment of bleeding junctional varices. Trop Gastroenterol. 2010;31(4):279–84.

    PubMed  Google Scholar 

  6. Takaki H, Yamakado K, Nakatsuka A, et al. Stent placement for portal venous stenosis following major abdominal surgery. Hepatogastroenterology. 2009;56(90):407–10.

    PubMed  Google Scholar 

  7. Saad WE. Portal interventions in liver transplant recipients. Semin Intervent Radiol. 2012;29(2):99–104.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Tsuruga Y, Kamachi H, Wakayama K, et al. Portal vein stenosis after pancreatectomy following neoadjuvant chemoradiation therapy for pancreatic cancer. World J Gastroenterol. 2013;19(16):2569–73.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Zhou ZQ, Lee JH, Song KB, et al. Clinical usefulness of portal venous stent in hepatobiliary pancreatic cancers. ANZ J Surg. 2014;84(5):346–52.

    Article  PubMed  Google Scholar 

  10. Yamakado K, Nakatsuka A, Tanaka N, et al. Portal venous stent placement in patients with pancreatic and biliary neoplasms invading portal veins and causing portal hypertension: initial experience. Radiology. 2001;220(1):150–6.

    Article  CAS  PubMed  Google Scholar 

  11. Novellas S, Denys A, Bize P, et al. Palliative portal vein stent placement in malignant and symptomatic extrinsic portal vein stenosis or occlusion. Cardiovasc Intervent Radiol. 2009;32(3):462–70.

    Article  PubMed  Google Scholar 

  12. Tsukamoto T, Hirohashi K, Kubo S, et al. Percutaneous transhepatic metallic stent placement for malignant portal vein stenosis. Hepatogastroenterology. 2003;50:453–5.

    PubMed  Google Scholar 

  13. Woodrum DA, Bjarnason H, Andrews JC. Portal vein venoplasty and stent placement in the nontransplant population. J Vasc Interv Radiol. 2009;20(5):593–9.

    Article  PubMed  Google Scholar 

  14. Nio Y, Iguchi C, Itakura M, Nishi T, et al. Placement of an expandable metallic stent improves the efficacy of chemoradiotherapy for pancreatic cancer with malignant portal vein stenosis or obstruction. Anticancer Res. 2009;29(8):3329–35.

    CAS  PubMed  Google Scholar 

  15. Fletcher JG, Wiersema MJ, Farrell MA, et al. Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT. Radiology. 2003;229(1):81–90.

    Article  PubMed  Google Scholar 

  16. Yamada Y, Mori H, Hijiya N, et al. Extrahepatic bile duct cancer: invasion of the posterior hepatic plexuses–evaluation using multidetector CT. Radiology. 2012;263(2):419–28.

    Article  PubMed  Google Scholar 

  17. Ito K, Higuchi M, Kada T, Mitchell DG, Nomura S, Honjo K, Fujita T, Awaya H, Matsumoto T, Matsunaga N. CT of acquired abnormalities of the portal venous system. Radiographics. 1997;17(4):897–917.

    Article  CAS  PubMed  Google Scholar 

  18. Zoli M, Merkel C, Magalotti D, Marchesini G, Gatta A, Pisi E. Evaluation of a new endoscopic index to predict first bleeding from the upper gastrointestinal tract in patients with cirrhosis. Hepatology. 1996;24(5):1047–52.

    Article  CAS  PubMed  Google Scholar 

  19. Denys A, Chevallier P, Doenz F, et al. Interventional radiology in the management of complications after liver transplantation. Eur Radiol. 2004;14:431–9.

    Article  PubMed  Google Scholar 

  20. Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol. 2003;14(9 Pt 2):S199–202.

    Article  PubMed  Google Scholar 

  21. Morita T, Tsunoda J, Inoue S, Chihara S. The Palliative Prognostic Index: a scoring system for survival prediction of terminally ill cancer patients. Support Care Cancer. 1999;7:128–33.

    Article  CAS  PubMed  Google Scholar 

  22. Stone CA, Tiernan E, Dooley BA. Prospective validation of the palliative prognostic index in patients with cancer. J Pain Symptom Manage. 2008;35(6):617–22.

    Article  PubMed  Google Scholar 

  23. Nieto Martín MD, Bernabeu Wittel M, de la Higuera Vila L, Mora Rufete A, Barón Franco B, Ollero Baturone M, en representación de los investigadores del proyecto PALIAR. Adaptation of the Palliative Prognostic Index in patients with advanced medical conditions. Rev Clin Esp. 2013;213(7):323–9.

    Article  PubMed  Google Scholar 

  24. Maltoni M, Scarpi E, Pittureri C, et al. Prospective comparison of prognostic scores in palliative care cancer populations. Oncologist. 2012;17(3):446–54.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Sultana A, Smith CT, Cunningham D, Starling N, Neoptolemos JP, Ghaneh P. Meta-analyses of chemotherapy for locally advanced and metastatic pancreatic cancer. J Clin Oncol. 2007;25(18):2607–15.

    Article  PubMed  Google Scholar 

  26. Rahma OE, Duffy A, Liewehr DJ, Steinberg SM, Greten TF. Second-line treatment in advanced pancreatic cancer: a comprehensive analysis of published clinical trials. Ann Oncol. 2013;24(8):1972–9. doi:10.1093/annonc/mdt166.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Glimelius B, Hoffman K, Sjödén PO, et al. Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer. Ann Oncol. 1996;7(6):593–600.

    Article  CAS  PubMed  Google Scholar 

  28. Fernández-Ruiz M, Guerra-Vales JM, Colina-Ruizdelgado F. Comorbidity negatively influences prognosis in patients with extrahepatic cholangiocarcinoma. World J Gastroenterol. 2009;15(42):5279–86.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Ortner ME, Caca K, Berr F, et al. Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study. Gastroenterology. 2003;125(5):1355–63.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

All authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Takaaki Hasegawa, Koichiro Yamakado, Haruyuki Takaki, Atsuhiro Nakatsuka, Junji Uraki, Takashi Yamanaka, Masashi Fujimori & Hajime Sakuma

  2. Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan

    Shugo Mizuno & Shuji Isaji

Authors
  1. Takaaki Hasegawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Koichiro Yamakado
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Haruyuki Takaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Atsuhiro Nakatsuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Junji Uraki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takashi Yamanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masashi Fujimori
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shugo Mizuno
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shuji Isaji
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hajime Sakuma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takaaki Hasegawa.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hasegawa, T., Yamakado, K., Takaki, H. et al. Portal Venous Stent Placement for Malignant Portal Venous Stenosis or Occlusion: Who Benefits?. Cardiovasc Intervent Radiol 38, 1515–1522 (2015). https://doi.org/10.1007/s00270-015-1123-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-015-1123-2

Keywords

Search

Navigation