Journal of vascular and interventional radiology : JVIR · 2025
Long-Term Outcomes of Angioplasty and Stent Placement for Portomesenteric Vein Obstruction following Hepatobiliary and Pancreatic Surgery.
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Park Jin Kam, Han Ahram, Hur Saebeom, Lee Myungsu, Jae Hwan Jun, Ahn Sanghyun, Min Sangil, Min Seung-Kee
Аннотация
PURPOSE: To evaluate the long-term outcomes of endovascular treatment for postoperative portomesenteric vein (PMV) obstruction and identify prognostic factors influencing patency rates.
MATERIALS AND METHODS: This retrospective single-center study included patients who underwent endovascular intervention for PMV stenosis or occlusion after hepatobiliary and pancreatic surgery between January 2009 and December 2020. Patient characteristics, technical outcomes, and long-term patency rates were evaluated. In total, 116 patients underwent PMV intervention after liver transplantation (n = 66, 56.9%), hepatectomy (n = 21, 18.1%), or pancreatectomy (n = 29, 25%). Interventions included balloon angioplasty alone (n = 7, 6%) or stent placement (n = 106, 91.4%), performed at a median of 125 days (interquartile range, 8.5-436.5 days) after surgery.
RESULTS: The technical success rate of the PMV intervention was 95.7%. Patency rates varied significantly across the surgical groups, with liver transplantation showing superior outcomes compared with hepatectomy and pancreatectomy (5-year primary patency rates: 94.4%, 65.4%, and 64.2%, respectively). Multivariate analysis revealed variceal bleeding (subdistribution hazard ratio [sHR], 8.49; 95% confidence interval [CI], 1.56-46.1; P = .013), stent length (sHR, 0.97; 95% CI, 0.95-0.99; P = .008), cumulative time (sHR, 0.32; 95% CI, 0.16-0.65; P = .002), and tumor etiology (sHR, 6.15; 95% CI, 1.02-36.99; P = .047) as independent prognostic factors for patency loss.
CONCLUSIONS: High technical success rates were achieved with the PMV interventions, with varying long-term patency rates. This study highlights the significance of the initial type of hepatobiliary and pancreatic surgery and clinical variables such as variceal bleeding, stent length, and tumor etiology in influencing PMV stenosis outcomes.
MATERIALS AND METHODS: This retrospective single-center study included patients who underwent endovascular intervention for PMV stenosis or occlusion after hepatobiliary and pancreatic surgery between January 2009 and December 2020. Patient characteristics, technical outcomes, and long-term patency rates were evaluated. In total, 116 patients underwent PMV intervention after liver transplantation (n = 66, 56.9%), hepatectomy (n = 21, 18.1%), or pancreatectomy (n = 29, 25%). Interventions included balloon angioplasty alone (n = 7, 6%) or stent placement (n = 106, 91.4%), performed at a median of 125 days (interquartile range, 8.5-436.5 days) after surgery.
RESULTS: The technical success rate of the PMV intervention was 95.7%. Patency rates varied significantly across the surgical groups, with liver transplantation showing superior outcomes compared with hepatectomy and pancreatectomy (5-year primary patency rates: 94.4%, 65.4%, and 64.2%, respectively). Multivariate analysis revealed variceal bleeding (subdistribution hazard ratio [sHR], 8.49; 95% confidence interval [CI], 1.56-46.1; P = .013), stent length (sHR, 0.97; 95% CI, 0.95-0.99; P = .008), cumulative time (sHR, 0.32; 95% CI, 0.16-0.65; P = .002), and tumor etiology (sHR, 6.15; 95% CI, 1.02-36.99; P = .047) as independent prognostic factors for patency loss.
CONCLUSIONS: High technical success rates were achieved with the PMV interventions, with varying long-term patency rates. This study highlights the significance of the initial type of hepatobiliary and pancreatic surgery and clinical variables such as variceal bleeding, stent length, and tumor etiology in influencing PMV stenosis outcomes.