title: Percutaneous unilateral placement of biliary covered metallic stent in patients with malignant hilar biliary obstruction and contralateral portal vein occlusion.
abstract: BACKGROUND
  Unilateral biliary metallic stent placement in the lobe with patent portal vein seemed to be a safe and effective palliative treatment of patients with contralateral portal vein occlusion caused by advanced hilar malignancy, obviating bilateral stent placement in these patients, because the hepatic lobe with portal vein occlusion ceases to produce bile due to interruption of enterohepatic circulation.
  
  
  OBJECTIVE
  To investigate the safety and efficacy of percutaneous unilateral expanded polytetrafluoroethylene (ePTFE)-covered stent placement in malignant hilar biliary obstruction with contralateral portal vein occlusion.
  
  
  METHODS
  From February 2008 to March 2011, 24 consecutive patients with malignant hilar biliary obstruction and unilobar portal vein occlusion were enrolled in this prospective study. All patients were treated by percutaneous placement of ePTFE-covered stents.
  
  
  RESULTS
  Stent deployment was technically successful in all patients. Two (8%) patients experienced minor self-limiting hemobilia. No major complication was noted. Successful internal drainage was achieved in 22 (91.6%) patients. Mean serum bilirubin level, which was 12.5 mg/dl ± 8.4 before drainage, decreased significantly to 2.7 mg/dl ± 3.4, 1 month after stent placement (P < 0.001). Median survival was 191 days (95% CI, 94-288 days) and cumulative stent patency rates at 1, 3, 6, 9, and 12 months were 100%, 95%, 95%, 95%, and 71%, respectively. Two (8%) patients presented with stent occlusion due to sludge incrustation. Aside from two patients who had died within 30 days after stent placement, the other 22 patients demonstrated slight decrease in diameter of undrained lobe and did not experience cholangitis nor jaundice.
  
  
  CONCLUSIONS
  Unilateral placement of ePTFE-covered stent in the lobe with patent portal vein seems to be a safe and effective method for palliative treatment of patients with contralateral portal vein occlusion. In addition, ePTFE-covered stent placement can prevent tumor ingrowth without functional occlusion of segmental bile ducts.
authors: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul,  Korea.
authors: Rang
authors: R
authors: Yi
authors: Dong Il
authors: DI
authors: Gwon
authors: Gi-Young
authors: GY
authors: Ko
authors: Hyun-Ki
authors: HK
authors: Yoon
authors: Jin Hyoung
authors: JH
authors: Kim
authors: Ji Hoon
authors: JH
authors: Shin
authors: Kyu-Bo
authors: KB
authors: Sung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications; D002758:Cholangiography; D049448:Cholangiopancreatography, Magnetic Resonance; D002779:Cholestasis / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D011138:Polytetrafluoroethylene; D011169:Portal Vein / Q000473:pathology*; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000628:therapy*
chemical_list: D008670:Metals; D011138:Polytetrafluoroethylene