Endovascular recanalization of symptomatic portomesenteric venous obstruction after pancreaticoduodenectomy and radiation.
Intraoperative radiation therapy (RT) may improve outcomes after pancreaticoduodenectomy for periampullary cancer; however, there is a 20% risk of late portomesenteric venous obstruction. This retrospective study evaluated the percutaneous treatment of portomesenteric venous obstruction that occurred a mean of 10 months after pancreaticoduodenectomy and intraoperative RT. Five patients with medically refractory ascites and portomesenteric obstruction on computed tomographic angiography had successful recanalization with elimination of the pressure gradient and no procedural complications. One patient showed no improvement clinically. Recurrent ascites after stent occlusion was successfully treated in two patients. Percutaneous transhepatic recanalization appears to be a safe and effective therapy in this population.
Section of Vascular and Interventional Radiology, Dartmouth-Hitchcock Medical Center and Norris Cotton Cancer Center, One Medical Center Drive, Lebanon, NH 03756, USA. eric.k.hoffer@hitchcock.org
Eric K
EK
Hoffer
Steven
S
Krohmer
John
J
Gemery
Bassem
B
Zaki
J Marc
JM
Pipas
D000230:Adenocarcinoma / Q000532:radiotherapy / Q000601:surgery; D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation; D001201:Ascites / Q000209:etiology / Q000628:therapy; D001650:Bile Duct Neoplasms / Q000532:radiotherapy / Q000601:surgery; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008642:Mesenteric Veins / Q000000981:diagnostic imaging; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000532:radiotherapy / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010690:Phlebography; D011169:Portal Vein / Q000000981:diagnostic imaging; D011172:Portography; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D013162:Splenic Vein / Q000000981:diagnostic imaging; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*