Outcomes of percutaneous interventions for managing stenosis after meso-rex bypass for extrahepatic portal vein obstruction

Lautz, T. B.; Kim, S. T.; Donaldson, J. S.; Superina, R. A.

J Vasc Interv Radiol. 2012 Mar 1; 23(3):377-83

Abstract

PURPOSE: To determine outcomes in children with extrahepatic portal vein obstruction who underwent percutaneous intervention for anastomotic stenosis after meso-Rex bypass. MATERIALS AND METHODS: Eighty-six patients who underwent meso-Rex bypass between 1997 and 2009 were retrospectively reviewed, and 15 who underwent transhepatic portal venography for graft stenosis were identified. Technical success and clinical outcomes were analyzed. RESULTS: Nine of 15 patients (60%) with anastomotic stenosis were successfully treated by endovascular techniques and remain symptom-free with patent shunts, three (20%) underwent technically successful interventions but currently have recurrent stenosis, and three (20%) underwent failed attempts at percutaneous intervention. All three in whom percutaneous intervention failed required surgical revision, including two with near-occlusive lesions that prevented traversal of the stenosis and one who developed postprocedure shunt thrombosis. In total, patients underwent 27 endovascular procedures, including 17 balloon venoplasties, four cutting balloon venoplasties, five stent placements, and one balloon venoplasty with thrombolysis. The mean pressure gradient across the stenosis decreased from 11 mm Hg +/- 3 to 5 mm Hg +/- 3 (P < .001) after technically successful intervention. Platelet count improved (from 97,000/muL +/- 41,000 to 165,000 +/- 67,000/muL; P = .002) and ammonia levels decreased (from 40 mumol/L +/- 11 to 24 mumol/L +/- 13; P = .05) after intervention. Patients were followed for a median duration of 39 months after the last intervention. CONCLUSIONS: Percutaneous interventions allow for long-term vein graft patency and clinical resolution of symptoms in the majority of patients with anastomotic stenosis after meso-Rex bypass.

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