Langenbeck's archives of surgery · 2025
Self-Expanding metal stent placement for hepatic venous outflow obstruction following ex vivo liver resection and autotransplantation.
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You Xinyu, Zuo Bangyou, Yang Chong, Liu Tao, Cheng Donghui, Peng Jiangji, Li Peng, Hao Jianjie, Zhang Yu
Аннотация
OBJECTIVE: To evaluate the safety and efficacy of self-expanding metal stents (SEMS) for managing hepatic venous outflow obstruction (HVOO) following ex vivo liver resection and autotransplantation (ELRA).
METHODS: We retrospectively analyzed patients who received SEMS placement for HVOO after ELRA between January 2018 and December 2024. The study analyzed details of vascular invasion, liver resection, vascular reconstruction during ELRA, and the condition before and after stent placement. Complications and short-term and long-term prognoses were also observed.
RESULTS: The study included 10 patients who underwent SEMS placement for HVOO after ELRA. Three patients had preoperative stent placement for Budd-Chiari syndrome. During ELRA, 3 patients underwent left trisegmentectomy, and 7 underwent right trisegmentectomy. Six patients required artificial vascular grafts for inferior vena cava (IVC) reconstruction, and 4 patients underwent partial IVC resection with bovine pericardial patch reconstruction. All patients underwent HV-IVC end-to-side anastomosis after HV widening. Two cases used allogeneic vein reconstruction for hepatic venous outflow. The median time to HVOO after ELRA was 3.0 [IQR 2.0-7.3] months. Three patients experienced left hepatic vein (LHV) obstruction, and 7 experienced right hepatic vein (RHV) obstruction, with a median hepatic venous pressure gradient (HVPG) of 11.8 [IQR 8.8-14.1] mmHg. After stent placement, the HVPG decreased to a median of 2.8 [IQR 2.1-3.1] mmHg. The median follow-up period was 29.5 [IQR 11.3-55.8] months. During follow-up, one patient developed restenosis; other than this, no complications of grade III or higher occurred.
CONCLUSION: In this single-center cohort, SEMS demonstrated favorable safety and efficacy for HVOO after ELRA, However, larger multicenter studies are required to validate these findings and assess long-term outcomes.
METHODS: We retrospectively analyzed patients who received SEMS placement for HVOO after ELRA between January 2018 and December 2024. The study analyzed details of vascular invasion, liver resection, vascular reconstruction during ELRA, and the condition before and after stent placement. Complications and short-term and long-term prognoses were also observed.
RESULTS: The study included 10 patients who underwent SEMS placement for HVOO after ELRA. Three patients had preoperative stent placement for Budd-Chiari syndrome. During ELRA, 3 patients underwent left trisegmentectomy, and 7 underwent right trisegmentectomy. Six patients required artificial vascular grafts for inferior vena cava (IVC) reconstruction, and 4 patients underwent partial IVC resection with bovine pericardial patch reconstruction. All patients underwent HV-IVC end-to-side anastomosis after HV widening. Two cases used allogeneic vein reconstruction for hepatic venous outflow. The median time to HVOO after ELRA was 3.0 [IQR 2.0-7.3] months. Three patients experienced left hepatic vein (LHV) obstruction, and 7 experienced right hepatic vein (RHV) obstruction, with a median hepatic venous pressure gradient (HVPG) of 11.8 [IQR 8.8-14.1] mmHg. After stent placement, the HVPG decreased to a median of 2.8 [IQR 2.1-3.1] mmHg. The median follow-up period was 29.5 [IQR 11.3-55.8] months. During follow-up, one patient developed restenosis; other than this, no complications of grade III or higher occurred.
CONCLUSION: In this single-center cohort, SEMS demonstrated favorable safety and efficacy for HVOO after ELRA, However, larger multicenter studies are required to validate these findings and assess long-term outcomes.