title: Transjugular endovascular recanalization of splenic vein in patients with regional portal hypertension complicated by gastrointestinal bleeding.
abstract: OBJECTIVE
  Regional portal hypertension (RPH) is an uncommon clinical syndrome resulting from splenic vein stenosis/occlusion, which may cause gastrointestinal (GI) bleeding from the esophagogastric varices. The present study evaluated the safety and efficacy of transjugular endovascular recanalization of splenic vein in patients with GI bleeding secondary to RPH.
  
  
  METHODS
  From December 2008 to May 2011, 11 patients who were diagnosed with RPH complicated by GI bleeding and had undergone transjugular endovascular recanalization of splenic vein were reviewed retrospectively. Contrast-enhanced computed tomography revealed splenic vein stenosis in six cases and splenic vein occlusion in five. Etiology of RPH was chronic pancreatitis (n = 7), acute pancreatitis with pancreatic pseudocyst (n = 2), pancreatic injury (n = 1), and isolated pancreatic tuberculosis (n = 1).
  
  
  RESULTS
  Technical success was achieved in 8 of 11 patients via the transjugular approach, including six patients with splenic vein stenosis and two patients with splenic vein occlusion. Two patients underwent splenic vein venoplasty only, whereas four patients underwent bare stents deployment and two covered stents. Splenic vein pressure gradient (SPG) was reduced from 21.5 ± 7.3 to 2.9 ± 1.4 mmHg after the procedure (P < 0.01). For the remaining three patients who had technical failures, splenic artery embolization and subsequent splenectomy was performed. During a median follow-up time of 17.5 (range, 3-34) months, no recurrence of GI bleeding was observed.
  
  
  CONCLUSIONS
  Transjugular endovascular recanalization of splenic vein is a safe and effective therapeutic option in patients with RPH complicated by GI bleeding and is not associated with an increased risk of procedure-related complications.
authors: Department of Gastroenterology, West China Hospital, Sichuan University, 37# Guoxue Lane, Chengdu, 610041, Sichuan, China.
authors: Xuefeng
authors: X
authors: Luo
authors: Ling
authors: L
authors: Nie
authors: Zhu
authors: Z
authors: Wang
authors: Jiaywei
authors: J
authors: Tsauo
authors: Chengwei
authors: C
authors: Tang
authors: Xiao
authors: X
authors: Li
mesh_terms: D000328:Adult; D003251:Constriction, Pathologic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D003287:Contrast Media; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D021621:Imaging, Three-Dimensional; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000150:complications / Q000000981:diagnostic imaging; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D013162:Splenic Vein / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media