Direct portal vein recanalization with stenting associated with embolization of esophagogastric varices in a patient with portal vein thrombosis. (September 2022)

• Record Type: Journal Article
• Authors: Lima da Rocha, Renan Danilo; Diniz, Paulo Inácio Alves Ramos; Leão, Alessandra Góes; Rodriguez, Juan Eduardo Rios; Campelo, Priscilla Ribeiro dos Santos; Souza, José Emerson dos Santos; Bernardes, Marcos Velludo; Cavalcante, Leonardo Pessoa
• Is Part Of: Annals of medicine and surgery. Volume 81(2022)
• Publication Date: 2022-09
• Subjects: Portal vein recanalization -- Portal vein occlusion -- Vascular surgical procedures -- Case report; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2022.104527
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Introduction: Chronic extrahepatic non-tumoral thrombotic portal vein occlusion in non-cirrhotic patients is a rare condition, affecting 5–10% of patients with portal hypertension. Presentation of case: The present study reports the case of a young patient without previous comorbidities who presented with portal hypertension secondary to chronic extrahepatic non-tumoral thrombotic occlusion of the portal vein. He underwent portal recanalization with a 12 × 80 mm nitinol self-expandable stent and embolization of esophagogastric varices with fibrous springs and cyanoacrylate via transparieto-hepatic access. Immediate resolution of the trans -lesion pressure gradient was obtained transoperatively, while complete remission of esophagogastric varices was verified by endoscopic control during outpatient follow-up. Discussion: Chronic portal vein occlusion is associated or not with liver cirrhosis. The chronic phase is characterized by cavernomatous transformation of the portal vein, which consists of the formation of multiple collaterals that bypass the lesion. This phase usually courses with portal hypertension and consequent variceal gastrointestinal bleeding. Decompression of the portal system through direct recanalization (angioplasty with stenting) is one therapeutic options. Conclusion: We conclude that, in the present case, resolving portal hypertension by direct portal recanalization was a good therapeutic option, as it decompressed the portal system while maintaining the hepatopetal flow. Highlights: Chronic extrahepatic non-tumoral thrombotic portal occlusion is a rare condition. Portal recanalization with stent for resolution of portal hypertension. Transparieto-hepatic access is the approach of choice among non-cirrhotics.