title: Portal Venous Stent Placement for Malignant Portal Venous Stenosis or Occlusion: Who Benefits?
abstract: OBJECTIVE
  The purpose of this study was to evaluate the efficacy of portal venous (PV) stent placement and find groups who benefit from this procedure among patients with symptomatic PV hypertension caused by malignant tumors.
  
  
  METHODS
  From October 2001 to January 2013, 13 patients underwent PV stent placement because of PV stenosis or occlusion caused by bile duct cancer (n = 7), pancreatic cancer (n = 5), or nodal metastasis (n = 1). Technical success, changes in PV pressure gradient and palliative prognostic index (PPI) scores before and after stent placement, clinical outcomes, and complications were evaluated.
  
  
  RESULTS
  Stent was successfully placed in all patients (100 %, 13/13), lowering the mean PV pressure gradient from 12.4 ± 4.5 mmHg (range 5-20 mmHg) to 0.5 ± 0.9 mmHg (range 0-3 mmHg, p < 0.000001). Symptoms were improved in all but one patient (92.3%, 12/13). Although 10 patients (76.9%, 10/13) with pre-stent placement PPI scores lower than 6 (mean 3.5 ± 1.7, range 0-5) were discharged from the hospital, the other 3 with the pre-stent placement PPI of 6 or more (mean 7.2 ± 1.6, range 6-9.5) died within 4 weeks (range 17-28 days) without discharge. The median survival time of discharged patients was 123 days, and it was 20 days in non-discharged patients (p = 0.0001). A major procedure-related complication of intraperitoneal hemorrhage occurred in one patient (7.7%, 1/13). No significant factor was detected for the occurrence of complication.
  
  
  CONCLUSIONS
  PV stent placement is a feasible, safe, and effective technique to relieve symptomatic PV hypertension caused by malignant tumors. The PPI score might be useful to stratify patients who benefit from this procedure.
authors.affiliation: Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan. hasegawat@clin.medic.mie-u.ac.jp.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Hasegawa
authors.affiliation: Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yamakado
authors.affiliation: Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Haruyuki
authors.initials: H
authors.lastname: Takaki
authors.affiliation: Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Nakatsuka
authors.affiliation: Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Uraki
authors.affiliation: Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamanaka
authors.affiliation: Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Fujimori
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
authors.forename: Shugo
authors.initials: S
authors.lastname: Mizuno
authors.affiliation: Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Isaji
authors.affiliation: Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Sakuma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D003251:Constriction, Pathologic / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Bile duct cancer; Palliative prognostic index; Pancreatic cancer; Portal venous stent