ANGIOPLASTY TREATMENT OF PORTAL-VEIN STENOSIS IN CHILDREN WITH SEGMENTAL LIVER-TRANSPLANTS - MIDTERM RESULTS

OBJECTIVE. Percutaneous venoplasty has showed excellent technical succ ess and excellent early results in treating portal vein stenoses in ch ildren with reduced-size liver transplants. We review the mid-term res ults in 22 children in whom portal venoplasty was attempted. SUBJECTS AND METHODS. During 27 months, percutaneous transhepatic portal venopl asty was attempted in 22 children with portal vein stenoses. Patients presented with symptoms of portal vein hypertension or were identified by routine surveillance with posttransplantation Doppler sonography. All stenoses were verified with angiography. Venoplasty was performed by direct puncture of an intrahepatic portal vein before balloon angio plasty of the stenotic segment. Patients were followed up with sonogra phic surveillance, and reintervention was performed as needed. In pati ents who had suboptimal results after portal venoplasty or who develop ed recurrent stenoses, intravascular stents were placed across stenose s. RESULTS. In 16 of 22 patients, initial clinical and technical succe ss was achieved. In the six patients who underwent unsuccessful proced ures, complete occlusion of the portal vein precluded access to the ex trahepatic portal vein. Of the 16 patients who underwent successful pr ocedures, intravascular stents were placed at the time of initial veno plasty in five patients for elastic stenosis. In seven other patients, portal vein restenosis occurred after venoplasty (mean, 6.3 months), necessitating intravascular stent placement. Four patients who underwe nt successful venoplasty without stent placement have required no furt her intervention. Portal vein patency has been maintained in all 16 pa tients who underwent technically successful procedures for 4-29 months (mean, 20 months). CONCLUSION. In children with reduced-size liver tr ansplants who experience delayed portal vein stenosis, percutaneous tr anshepatic portal venoplasty has achieved encouraging mid-term results . It is the procedure of choice in our hospital and often eliminates t he need for surgical revision, portacaval shunting, or retransplantati on.