Portal Vein Venoplasty and Stent Placement in the Nontransplant Population

Purpose: To review the technical success and results of attempted transcatheter management of portal vein (PV) stenosis and occlusion in the nontransplant population. Materials and Methods: All patients referred for percutaneous management of PV stenosis or occlusion between January 1997 and July 2007 were included in this review. Patients were included on an intent-to-treat basis, but liver transplant recipients were excluded. Intervention was attempted in 18 patients. Access to the portal system was achieved by the transhepatic route in 17 of 18 patients and by way of a preexisting transjugular intrahepatic portosystemic shunt in the other one. Indications for intervention included gastrointestinal bleeding (n = 8), ascites (n = 3), hemorrhage and ascites (n = 4), preoperative decompression of varices (n = 2), and intestinal angina (n = 1). Etiology of the PV stenosis or occlusion was postsurgical (n = 9), tumor encasement (n = 5), pancreatitis (n = 3), and unknown (n = 1). Results: Lesions were successfully crossed with a stent in 14 of 18 patients. Successful decompression of the portal system was achieved in 13 of 14. In one of 14 patients, the varices were not decompressed as a result of competitive flow. In four of 18 patients, the lesion could not be crossed. In the 13 technically successful cases in which the portal varices were decompressed, there was resolution of clinical symptoms with no immediate periprocedural complications. Conclusions: PV stent placement is safe, with an acceptable success rate, and provides symptomatic relief from the sequelae of presinusoidal portal hypertension.