[Percutaneous transhepatic metallic stent placement for the treatment of post-transplantation portal vein stenosis].
Liver transplantation is a routinely used therapeutic choice in the treatment of end stage liver disease. Portal vein stenosis is a rare vascular complication after liver transplantation. We report the interventional radiological management of three cases of portal vein stenosis.


OBJECTIVE
The surgical management of portal vein stenosis can be hazardous for the patient and the transplanted liver in the early post-transplantation period. In general, interventional radiological methods are tolerable for patients and can be safely performed with high success rate. The aim of this report is to analyze the feasibility, the risks and the efficacy of the percutaneous transhepatic self expanding metallic stent placement into the portal vein.


METHODS
Three of the 396 liver transplantations cases in Budapest developed significant portal vein stenosis. In these cases, ultrasound guided percutaneous transhepatic portal vein puncture with fine needle was performed. The tract was dilated with a coaxial dilator set, and an adequately sized sheath introducer was inserted into the liver parenchyma. Two nitinol and one stainless steel self expanding metallic stent were implanted at the stenotic portal vein anastomoses. The tract was embolized with gelfoam particles (1 case), or coils (1 case). In the third patient no tract embolization was performed.


RESULTS
All treatments were technically successful, without minor or major complications. In two cases the amount of free abdominal fluid decreased significantly, and in the third case the esophageal varicosity regressed. The morphological success was documented with ultrasound and computed tomography examination. Two patients are alive and well after 10 and 39 months of follow up, while the third patient died after one month in multi organ failure.


CONCLUSIONS
Percutaneous transhepatic metallic stent placement for the treatment of post-transplantation portal vein stenosis is a safe and effective method.
Doros
Attila
A
Semmelweis Egyetem, Altalános Orvostudományi Kar, Transzplantációs és Sebészeti Klinika, Budapest. dorattila@yahoo.com
Nemes
Balázs
B
Fehérvári
Imre
I
Görög
Dénes
D
Gerlei
Zsuzsa
Z
Németh
Andrea
A
Hartmann
Erika
E
Deák
Akos Pál
AP
Fazakas
János
J
Tóth
Szabolcs
S
Kóbori
László
L
D000328:Adult; D000714:Anastomosis, Surgical; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology* / Q000601:surgery*; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D018617:Ultrasonography, Doppler, Pulsed; D014654:Vascular Patency