Successful management of cavernous transformation of portal vein in a child using percutaneous transhepatic portal vein recanalization by endovascular approach_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WEI Bo ¹ , WU Hao ¹ , ZHANG Jingyi ² , XIE Xiaolong ³ , XIANG Bo ³ ,  LI Kewei ³

1. Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

LI Kewei, Email: vivian5225133@outlook.com

Keywords：

cavernous transformation of portal vein; percutaneous transhepatic portal vein recanalization; interventional therapy

DOI：

10.7507/1007-9424.202302050

Video：

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Objective To summarize the treatment and experience of percutaneous transhepatic portal vein recanalization by endovascular approach for treatment of cavernous transformation of the portal vein (CTPV) in a child. Method The clinical data of a child with idiopathic CTPV who underwent percutaneous transhepatic portal vein recanalization by endovascular approach were retrospectively analyzed. Results We described a novel percutaneous transhepatic portal vein recanalization approach that had successfully treated a child with idiopathic CTPV following a multidisciplinary team evaluation. The operation time was 1.5 h and blood loss was approximately 1 mL. The child recovered uneventfully at 9-month follow-up, without any clinical evidence of CTPV complications. Conclusion In light of our successful management, we can envision that the portal vein recanalization is an important therapeutic supplement for treating CTPV and will result in a paradigm change.

Citation： WEI Bo, WU Hao, ZHANG Jingyi, XIE Xiaolong, XIANG Bo, LI Kewei. Successful management of cavernous transformation of portal vein in a child using percutaneous transhepatic portal vein recanalization by endovascular approach. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(4): 397-402. doi: 10.7507/1007-9424.202302050 Copy

1.	Barakat MT, Foley MA, Gugig R. Initial experience with endoscopic ultrasound-guided coil placement for pediatric gastric variceal hemostasis. J Pediatr Gastroenterol Nutr, 2021, 72(4): 532-537.
2.	Mörk H, Weber P, Schmidt H, et al. Cavernous transformation of the portal vein associated with common bile duct strictures: report of two cases. Gastrointest Endosc, 1998, 47(1): 79-83.
3.	Marot A, Barbosa JV, Duran R, et al. Percutaneous portal vein recanalization using self-expandable nitinol stents in patients with non-cirrhotic non-tumoral portal vein occlusion. Diagn Interv Imaging, 2019, 100(3): 147-156.
4.	de Ville de Goyet J, Alberti D, Falchetti D, et al. Treatment of extrahepatic portal hypertension in children by mesenteric-to-left portal vein bypass: a new physiological procedure. Eur J Surg, 1999, 165(8): 777-781.
5.	Shneider BL, de Ville de Goyet J, Leung DH, et al. Primary prophylaxis of variceal bleeding in children and the role of MesoRex bypass: summary of the Baveno Ⅵ pediatric satellite symposium. Hepatology, 2016, 63(4): 1368-1380.
6.	Zhang J, Li L. Rex shunt for extra-hepatic portal venous obstruction in children. Children (Basel), 2022, 9(2): 297. doi: 10.3390/children9020297.
7.	Tantemsapya N, Superina R, Wang D, et al. Hepatic histology and morphometric measurements in idiopathic extrahepatic portal vein thrombosis in children, correlated to clinical outcome of Meso-Rex bypass. Ann Surg, 2018, 267(6): 1179-1184.
8.	Elnaggar AS, Griesemer AD, Bentley-Hibbert S, et al. Liver atrophy and regeneration in noncirrhotic portal vein thrombosis: effect of surgical shunts. Liver Transpl, 2018, 24(7): 881-887.
9.	Lautz TB, Keys LA, Melvin JC, et al. Advantages of the Meso-Rex bypass compared with portosystemic shunts in the management of extrahepatic portal vein obstruction in children. J Am Coll Surg, 2013, 216(1): 83-89.
10.	Glatard AS, Hillaire S, d’Assignies G, et al. Obliterative portal venopathy: findings at CT imaging. Radiology, 2012, 263(3): 741-750.
11.	Mack CL, Zelko FA, Lokar J, et al. Surgically restoring portal blood flow to the liver in children with primary extrahepatic portal vein thrombosis improves fluid neurocognitive ability. Pediatrics, 2006, 117(3): e405-e412. doi: 10.1542/peds.2005-1177.
12.	Chocarro G, Junco PT, Dominguez E, et al. Portal cavernoma in the era of mesoportal shunt (Rex) and liver transplant in children. Eur J Pediatr Surg, 2016, 26(1): 7-12.
13.	de Franchis R, Baveno VIF. Expanding consensus in portal hypertension: report of the Baveno Ⅵ consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol, 2015, 63(3): 743-752.
14.	Li L, Zhang JS, Chen Z, et al. Portal-to-right portal vein bypass for extrahepatic portal vein obstruction. J Pediatr Surg, 2018, 53(7): 1403-1407.
15.	Tang R, Yu L, Wu G, et al. Modified Meso-Rex bypass with umbilical vein recanalization and intra-operative stenting. Langenbecks Arch Surg, 2021, 406(7): 2553-2562.
16.	Zhang H, Zhang N, Li M, et al. Surgical treatment of portal vein cavernous transformation. World J Surg, 2004, 28(7): 708-711.
17.	Orloff MJ. Fifty-three years’ experience with randomized clinical trials of emergency portacaval shunt for bleeding esophageal varices in cirrhosis: 1958-2011. JAMA Surg, 2014, 149(2): 155-169.
18.	Ouchi K, Tominaga T, Unno M, et al. Obstructive jaundice associated with extrahepatic portal vein obstruction: report of two cases. Surg Today, 1993, 23(8): 737-741.
19.	Scantlebury VP, Zajko AB, Esquivel CO, et al. Successful reconstruction of late portal vein stenosis after hepatic transplantation. Arch Surg, 1989, 124(4): 503-505.
20.	Raby N, Karani J, Thomas S, et al. Stenoses of vascular anastomoses after hepatic transplantation: treatment with balloon angioplasty. AJR Am J Roentgenol, 1991, 157(1): 167-171.
21.	Wei B, Huang Z, Wu H, et al. Portal vein recanalization for noncirrhotic portal vein cavernous transformation: transjugular intrahepatic portosystemic shunt creation versus portal vein stent placement. J Vasc Interv Radiol, 2023, 34(2): 187-194.
22.	de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno Ⅶ—renewing consensus in portal hypertension. J Hepatol, 2022, 76(4): 959-974.
23.	Wei B, Zhang L, Tong H, et al. Cavernous transformation of the portal vein in a 26-month old boy treated by transjugular intrahepatic portosystemic shunt: a case report. Front Pediatr, 2019, 7: 379. doi: 10.3389/fped.2019.00379.
24.	Ghannam JS, Cline MR, Hage AN, et al. Technical success and outcomes in pediatric patients undergoing transjugular intrahepatic portosystemic shunt placement: a 20-year experience. Pediatr Radiol, 2019, 49(1): 128-135.
25.	张晓武, 李肖. 经颈内静脉肝内门体分流术治疗门静脉高压症. 中国普外基础与临床杂志, 2015, 22(11): 1310-1313.
26.	David A, Metairie S, Perret C, et al. Minilaparotomy-assisted transmesenteric approach for portal vein recanalization and transjugular intrahepatic portosystemic shunt in a non-cirrhotic patient with portal cavernoma. Diagn Interv Imaging, 2020, 101(6): 417-419.
27.	Miraglia R, Maruzzelli L, Caruso S, et al. Successful portal vein stent placement in a child with cavernomatous replacement of the portal vein after partial liver transplantation: the importance of a recognizable portal vein remnant. Cardiovasc Intervent Radiol, 2015, 38(6): 1658-1662.

1. Barakat MT, Foley MA, Gugig R. Initial experience with endoscopic ultrasound-guided coil placement for pediatric gastric variceal hemostasis. J Pediatr Gastroenterol Nutr, 2021, 72(4): 532-537.
2. Mörk H, Weber P, Schmidt H, et al. Cavernous transformation of the portal vein associated with common bile duct strictures: report of two cases. Gastrointest Endosc, 1998, 47(1): 79-83.
3. Marot A, Barbosa JV, Duran R, et al. Percutaneous portal vein recanalization using self-expandable nitinol stents in patients with non-cirrhotic non-tumoral portal vein occlusion. Diagn Interv Imaging, 2019, 100(3): 147-156.
4. de Ville de Goyet J, Alberti D, Falchetti D, et al. Treatment of extrahepatic portal hypertension in children by mesenteric-to-left portal vein bypass: a new physiological procedure. Eur J Surg, 1999, 165(8): 777-781.
5. Shneider BL, de Ville de Goyet J, Leung DH, et al. Primary prophylaxis of variceal bleeding in children and the role of MesoRex bypass: summary of the Baveno Ⅵ pediatric satellite symposium. Hepatology, 2016, 63(4): 1368-1380.
6. Zhang J, Li L. Rex shunt for extra-hepatic portal venous obstruction in children. Children (Basel), 2022, 9(2): 297. doi: 10.3390/children9020297.
7. Tantemsapya N, Superina R, Wang D, et al. Hepatic histology and morphometric measurements in idiopathic extrahepatic portal vein thrombosis in children, correlated to clinical outcome of Meso-Rex bypass. Ann Surg, 2018, 267(6): 1179-1184.
8. Elnaggar AS, Griesemer AD, Bentley-Hibbert S, et al. Liver atrophy and regeneration in noncirrhotic portal vein thrombosis: effect of surgical shunts. Liver Transpl, 2018, 24(7): 881-887.
9. Lautz TB, Keys LA, Melvin JC, et al. Advantages of the Meso-Rex bypass compared with portosystemic shunts in the management of extrahepatic portal vein obstruction in children. J Am Coll Surg, 2013, 216(1): 83-89.
10. Glatard AS, Hillaire S, d’Assignies G, et al. Obliterative portal venopathy: findings at CT imaging. Radiology, 2012, 263(3): 741-750.
11. Mack CL, Zelko FA, Lokar J, et al. Surgically restoring portal blood flow to the liver in children with primary extrahepatic portal vein thrombosis improves fluid neurocognitive ability. Pediatrics, 2006, 117(3): e405-e412. doi: 10.1542/peds.2005-1177.
12. Chocarro G, Junco PT, Dominguez E, et al. Portal cavernoma in the era of mesoportal shunt (Rex) and liver transplant in children. Eur J Pediatr Surg, 2016, 26(1): 7-12.
13. de Franchis R, Baveno VIF. Expanding consensus in portal hypertension: report of the Baveno Ⅵ consensus workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol, 2015, 63(3): 743-752.
14. Li L, Zhang JS, Chen Z, et al. Portal-to-right portal vein bypass for extrahepatic portal vein obstruction. J Pediatr Surg, 2018, 53(7): 1403-1407.
15. Tang R, Yu L, Wu G, et al. Modified Meso-Rex bypass with umbilical vein recanalization and intra-operative stenting. Langenbecks Arch Surg, 2021, 406(7): 2553-2562.
16. Zhang H, Zhang N, Li M, et al. Surgical treatment of portal vein cavernous transformation. World J Surg, 2004, 28(7): 708-711.
17. Orloff MJ. Fifty-three years’ experience with randomized clinical trials of emergency portacaval shunt for bleeding esophageal varices in cirrhosis: 1958-2011. JAMA Surg, 2014, 149(2): 155-169.
18. Ouchi K, Tominaga T, Unno M, et al. Obstructive jaundice associated with extrahepatic portal vein obstruction: report of two cases. Surg Today, 1993, 23(8): 737-741.
19. Scantlebury VP, Zajko AB, Esquivel CO, et al. Successful reconstruction of late portal vein stenosis after hepatic transplantation. Arch Surg, 1989, 124(4): 503-505.
20. Raby N, Karani J, Thomas S, et al. Stenoses of vascular anastomoses after hepatic transplantation: treatment with balloon angioplasty. AJR Am J Roentgenol, 1991, 157(1): 167-171.
21. Wei B, Huang Z, Wu H, et al. Portal vein recanalization for noncirrhotic portal vein cavernous transformation: transjugular intrahepatic portosystemic shunt creation versus portal vein stent placement. J Vasc Interv Radiol, 2023, 34(2): 187-194.
22. de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno Ⅶ—renewing consensus in portal hypertension. J Hepatol, 2022, 76(4): 959-974.
23. Wei B, Zhang L, Tong H, et al. Cavernous transformation of the portal vein in a 26-month old boy treated by transjugular intrahepatic portosystemic shunt: a case report. Front Pediatr, 2019, 7: 379. doi: 10.3389/fped.2019.00379.
24. Ghannam JS, Cline MR, Hage AN, et al. Technical success and outcomes in pediatric patients undergoing transjugular intrahepatic portosystemic shunt placement: a 20-year experience. Pediatr Radiol, 2019, 49(1): 128-135.
25. 张晓武, 李肖. 经颈内静脉肝内门体分流术治疗门静脉高压症. 中国普外基础与临床杂志, 2015, 22(11): 1310-1313.
26. David A, Metairie S, Perret C, et al. Minilaparotomy-assisted transmesenteric approach for portal vein recanalization and transjugular intrahepatic portosystemic shunt in a non-cirrhotic patient with portal cavernoma. Diagn Interv Imaging, 2020, 101(6): 417-419.
27. Miraglia R, Maruzzelli L, Caruso S, et al. Successful portal vein stent placement in a child with cavernomatous replacement of the portal vein after partial liver transplantation: the importance of a recognizable portal vein remnant. Cardiovasc Intervent Radiol, 2015, 38(6): 1658-1662.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Successful management of cavernous transformation of portal vein in a child using percutaneous transhepatic portal vein recanalization by endovascular approach

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