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Portal vein recanalisation alone to treat severe portal hypertension in non-cirrhotic patients with chronic extrahepatic portal vein obstruction

BACKGROUND & AIMS: We aimed to evaluate long-term outcome of patients with chronic non-cirrhotic extrahepatic portal vein obstruction (CNC-EHPVO) who underwent portal vein recanalisation (PVR) without transjugular intrahepatic portosystemic shunt (TIPS) insertion and to determine factors predict...

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Autores principales: Artru, Florent, Vietti-Violi, Naik, Sempoux, Christine, Vieira Barbosa, Joana, Becce, Fabio, Sah, Nelly, Marot, Astrid, Deltenre, Pierre, Moschouri, Eleni, Fraga, Montserrat, Hocquelet, Arnaud, Duran, Rafael, Moradpour, Darius, Rautou, Pierre-Emmanuel, Denys, Alban
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9253474/
https://www.ncbi.nlm.nih.gov/pubmed/35801087
http://dx.doi.org/10.1016/j.jhepr.2022.100511
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author Artru, Florent
Vietti-Violi, Naik
Sempoux, Christine
Vieira Barbosa, Joana
Becce, Fabio
Sah, Nelly
Marot, Astrid
Deltenre, Pierre
Moschouri, Eleni
Fraga, Montserrat
Hocquelet, Arnaud
Duran, Rafael
Moradpour, Darius
Rautou, Pierre-Emmanuel
Denys, Alban
author_facet Artru, Florent
Vietti-Violi, Naik
Sempoux, Christine
Vieira Barbosa, Joana
Becce, Fabio
Sah, Nelly
Marot, Astrid
Deltenre, Pierre
Moschouri, Eleni
Fraga, Montserrat
Hocquelet, Arnaud
Duran, Rafael
Moradpour, Darius
Rautou, Pierre-Emmanuel
Denys, Alban
author_sort Artru, Florent
collection PubMed
description BACKGROUND & AIMS: We aimed to evaluate long-term outcome of patients with chronic non-cirrhotic extrahepatic portal vein obstruction (CNC-EHPVO) who underwent portal vein recanalisation (PVR) without transjugular intrahepatic portosystemic shunt (TIPS) insertion and to determine factors predicting PVR failure and stent occlusion. METHODS: This retrospective monocentric study included all patients who underwent PVR without TIPS insertion in the context of CNC-EHPVO between the years 2000 and 2019. Primary patency was defined by the absence of a complete stent occlusion on follow-up imaging. RESULTS: A total of 31 patients underwent PVR with a median follow-up of 52 months (24–82 months). Indications were gastrointestinal bleeding (n = 13), abdominal pain attributed to CNC-EHPVO (n = 7), prior to abdominal surgery (n = 4), and others (n = 7). Technical success was obtained in 27 patients. PVR failure was associated with extension within the intrahepatic portal veins (p = 0.005) and recanalisation for abdominal pain (p = 0.02). Adverse events occurred in 6 patients with no mortality. Anticoagulation was administered in 21 patients after technical success of PVR. In patients with technical success, 5-year primary patency was 73% and was associated with improved muscle mass (p = 0.007) and decreased spleen volume (p = 0.01) at 1 year. Furthermore, 21 (78%) patients with PVR technical success were free of portal hypertension complication at 5 years. CONCLUSIONS: PVR without TIPS insertion was feasible and safe in selected patients with CNC-EHPVO and portal hypertension with past or expected complications. Primary patency at 5 years was obtained in 3 of 4 patients with technical success of PVR and was associated with a control of complications of CNC-EHPVO. PVR was associated with improvement of sarcopenia and decreased spleen volume at 1 year. LAY SUMMARY: Patients with chronic obstruction of the portal vein and without cirrhosis or malignancy can develop complications related to the high pressure in the venous system. The present study reports long-term favourable outcome of patients in whom the obstruction was treated with stents.
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spelling pubmed-92534742022-07-06 Portal vein recanalisation alone to treat severe portal hypertension in non-cirrhotic patients with chronic extrahepatic portal vein obstruction Artru, Florent Vietti-Violi, Naik Sempoux, Christine Vieira Barbosa, Joana Becce, Fabio Sah, Nelly Marot, Astrid Deltenre, Pierre Moschouri, Eleni Fraga, Montserrat Hocquelet, Arnaud Duran, Rafael Moradpour, Darius Rautou, Pierre-Emmanuel Denys, Alban JHEP Rep Research Article BACKGROUND & AIMS: We aimed to evaluate long-term outcome of patients with chronic non-cirrhotic extrahepatic portal vein obstruction (CNC-EHPVO) who underwent portal vein recanalisation (PVR) without transjugular intrahepatic portosystemic shunt (TIPS) insertion and to determine factors predicting PVR failure and stent occlusion. METHODS: This retrospective monocentric study included all patients who underwent PVR without TIPS insertion in the context of CNC-EHPVO between the years 2000 and 2019. Primary patency was defined by the absence of a complete stent occlusion on follow-up imaging. RESULTS: A total of 31 patients underwent PVR with a median follow-up of 52 months (24–82 months). Indications were gastrointestinal bleeding (n = 13), abdominal pain attributed to CNC-EHPVO (n = 7), prior to abdominal surgery (n = 4), and others (n = 7). Technical success was obtained in 27 patients. PVR failure was associated with extension within the intrahepatic portal veins (p = 0.005) and recanalisation for abdominal pain (p = 0.02). Adverse events occurred in 6 patients with no mortality. Anticoagulation was administered in 21 patients after technical success of PVR. In patients with technical success, 5-year primary patency was 73% and was associated with improved muscle mass (p = 0.007) and decreased spleen volume (p = 0.01) at 1 year. Furthermore, 21 (78%) patients with PVR technical success were free of portal hypertension complication at 5 years. CONCLUSIONS: PVR without TIPS insertion was feasible and safe in selected patients with CNC-EHPVO and portal hypertension with past or expected complications. Primary patency at 5 years was obtained in 3 of 4 patients with technical success of PVR and was associated with a control of complications of CNC-EHPVO. PVR was associated with improvement of sarcopenia and decreased spleen volume at 1 year. LAY SUMMARY: Patients with chronic obstruction of the portal vein and without cirrhosis or malignancy can develop complications related to the high pressure in the venous system. The present study reports long-term favourable outcome of patients in whom the obstruction was treated with stents. Elsevier 2022-05-25 /pmc/articles/PMC9253474/ /pubmed/35801087 http://dx.doi.org/10.1016/j.jhepr.2022.100511 Text en © 2022 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Research Article
Artru, Florent
Vietti-Violi, Naik
Sempoux, Christine
Vieira Barbosa, Joana
Becce, Fabio
Sah, Nelly
Marot, Astrid
Deltenre, Pierre
Moschouri, Eleni
Fraga, Montserrat
Hocquelet, Arnaud
Duran, Rafael
Moradpour, Darius
Rautou, Pierre-Emmanuel
Denys, Alban
Portal vein recanalisation alone to treat severe portal hypertension in non-cirrhotic patients with chronic extrahepatic portal vein obstruction
title Portal vein recanalisation alone to treat severe portal hypertension in non-cirrhotic patients with chronic extrahepatic portal vein obstruction
title_full Portal vein recanalisation alone to treat severe portal hypertension in non-cirrhotic patients with chronic extrahepatic portal vein obstruction
title_fullStr Portal vein recanalisation alone to treat severe portal hypertension in non-cirrhotic patients with chronic extrahepatic portal vein obstruction
title_full_unstemmed Portal vein recanalisation alone to treat severe portal hypertension in non-cirrhotic patients with chronic extrahepatic portal vein obstruction
title_short Portal vein recanalisation alone to treat severe portal hypertension in non-cirrhotic patients with chronic extrahepatic portal vein obstruction
title_sort portal vein recanalisation alone to treat severe portal hypertension in non-cirrhotic patients with chronic extrahepatic portal vein obstruction
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9253474/
https://www.ncbi.nlm.nih.gov/pubmed/35801087
http://dx.doi.org/10.1016/j.jhepr.2022.100511
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