Portal venous stent placement in patients with pancreatic and biliary neoplasms invading portal veins and causing portal hypertension: Initial experience

PURPOSE: To evaluate the clinical usefulness of portal venous stent placeme nt in patients with pancreatic or biliary neoplasms invading portal veins a nd causing portal hypertension. MATERIALS AND METHODS: Thirteen patients underwent portal venous stent plac ement because of gastrointestinal bleeding (n = 8), risk of gastroesophagea l varix rupture (n = 4), ascites (n = 4), thrombocytopenia (n = 3), and/or portal venous thrombosis (n = 3). The main portal vein or both the intrahep atic and main portal veins were invaded in six patients (group A). The main portal vein and splanchnic veins were involved in seven patients (group B) . Stents were placed across the stenotic (n = 8) or occluded (n = 5) lesion s after percutaneous transhepatic portography. Changes in portal venous pre ssure, stent patency, and survival were evaluated. RESULTS: Mean portal venous pressure decreased significantly immediately af ter stent placement, from 24.9 mm Hg +/- 5.9 (SD) to 1.8 mm Hg +/- 4.6 (P < .001). In group A, blood flow through the stent was maintained and the sym ptoms had subsided at follow-up (mean, 12.5 months). In group B, symptoms w ere improved in five patients, but the stents were occluded in ail-but one patient at a mean follow-up of 7.5 months. There was a significant differen ce in stent patency between the patients with (14%) and those without (100% ) splanchnic venous involvement (P < .01). CONCLUSION: Stent placement helped to relieve portal hypertension symptoms. Splanchnic venous involvement was associated with worse stent patency.