title: Outcomes of percutaneous interventions for managing stenosis after meso-Rex bypass for extrahepatic portal vein obstruction.
abstract: OBJECTIVE
  To determine outcomes in children with extrahepatic portal vein obstruction who underwent percutaneous intervention for anastomotic stenosis after meso-Rex bypass.
  
  
  METHODS
  Eighty-six patients who underwent meso-Rex bypass between 1997 and 2009 were retrospectively reviewed, and 15 who underwent transhepatic portal venography for graft stenosis were identified. Technical success and clinical outcomes were analyzed.
  
  
  RESULTS
  Nine of 15 patients (60%) with anastomotic stenosis were successfully treated by endovascular techniques and remain symptom-free with patent shunts, three (20%) underwent technically successful interventions but currently have recurrent stenosis, and three (20%) underwent failed attempts at percutaneous intervention. All three in whom percutaneous intervention failed required surgical revision, including two with near-occlusive lesions that prevented traversal of the stenosis and one who developed postprocedure shunt thrombosis. In total, patients underwent 27 endovascular procedures, including 17 balloon venoplasties, four cutting balloon venoplasties, five stent placements, and one balloon venoplasty with thrombolysis. The mean pressure gradient across the stenosis decreased from 11 mm Hg ± 3 to 5 mm Hg ± 3 (P < .001) after technically successful intervention. Platelet count improved (from 97,000/μL ± 41,000 to 165,000 ± 67,000/μL; P = .002) and ammonia levels decreased (from 40 μmol/L ± 11 to 24 μmol/L ± 13; P = .05) after intervention. Patients were followed for a median duration of 39 months after the last intervention.
  
  
  CONCLUSIONS
  Percutaneous interventions allow for long-term vein graft patency and clinical resolution of symptoms in the majority of patients with anastomotic stenosis after meso-Rex bypass.
authors.affiliation: Department of Surgery, Children's Memorial Hospital, Northwestern University, Chicago, IL 60614, USA.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Lautz
authors.forename: Stanley T
authors.initials: ST
authors.lastname: Kim
authors.forename: James S
authors.initials: JS
authors.lastname: Donaldson
authors.forename: Riccardo A
authors.initials: RA
authors.lastname: Superina
mesh_terms: D000293:Adolescent; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000295:instrumentation; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D007087:Illinois; D007223:Infant; D008297:Male; D010690:Phlebography; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency