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Percutaneous transhepatic stent placement for palliation of symptomatic portal hypertension due to extrinsic extrahepatic portomesenteric venous stenosis in cancer patients
SUNDAY: Scientific Sessions
S52
’
Sunday
Scientific Session
(66.6%). Four patients did not show improvement in their hydrothorax both clinically and radiographically (26.6%) during one-week period. Mean MELD score for patients with improvement in hydrothorax was 16.4. Mean MELD score for patients with no improvement in hydrothorax was 29. All patients with no improvement in hydrothorax had MELD scores above 20. Yet, two patients with MELD scores greater than 20 also benefited from TIPS. Greater than 5 mmHg or 37.5 % reduction (range 6-22 mmHg) in portosystemic gradient pressure was achieved in patients with improvement in hydrothorax. On the other hand, equal to or less than 5 mmHg (range 2-5 mmHg) in portosystemic pressure gradient was achieved in patients with no improvement in hydrothorax. Conclusions: Our study supports previously reported efficacy of TIPS for refractory hydrothorax. In addition, our study also suggests that less than 5 mmHg or 45% reduction in portosystemic pressure gradient and high MELD scores may predict unsuccessful short-term outcome of TIPS for refractory hydrothorax. Reference 1. Brooke E, et al. Safety and Efficacy of Transjugular Intrahepatic Portosystemic Shunt Creation for the Treatment of Hepatic Hydrothorax Spencer. J Vasc Interv Radiol 13(4):385-439.
4:21 PM
Abstract No. 108
Percutaneous transhepatic stent placement for palliation of symptomatic portal hypertension due to extrinsic extrahepatic portomesenteric venous stenosis in cancer patients P. Parmet, S. Sabir, M. Wallace; MD Anderson Cancer Center, Houston, TX
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JVIR
Purpose: This study was performed to evaluate the efficacy of transhepatic stent placement in the palliation of cancer patients with refractory ascites and/or variceal bleeding due to extrahepatic portomesenteric venous stenosis. Materials: We retrospectively reviewed the records of 38 consecutive patients who underwent percutaneous transhepatic portal venous stenting between January 2007 and July 2015. A total of 28 patients met study inclusion criteria consisting of extrahepatic portomesenteric venous stenosis with primary indication being palliation of refractory ascites or gastrointestinal bleeding. Technical success, clinical success (initial and duration), and overall survival were evaluated. A measure we call fraction of remaining life palliated, which is duration of clinical success divided by overall survival, is reported. Additional characteristics reviewed include etiology of stenosis and morphology of stent deployment. Routine imaging surveillance for stent patency was not performed. Results: Median patient age at treatment was 60 years (range 7 – 79) with male predominance (61%). Pancreatic adenocarcinoma was the most common primary malignancy (21/28). Technical success was achieved in 93% of patients, with clinical success on initial follow up achieved in 86%. For patients successfully stented, average fraction of remaining life palliated was 0.87; and median overall survival was 358 days, including 7 patients still being followed at the time of data analysis. There were no procedure-related complications. In subgroup analysis, average fraction of remaining life palliated trended lower with narrowing due to malignant stenosis (0.86, n ¼ 22) versus post-treatment change (0.95, n ¼ 4); stent deployment crossing the portal confluence (0.81, n ¼ 18) versus single vessel deployment (0.97, n ¼ 8); and refractory ascites (0.81, n ¼ 15) versus bleeding (0.97, n ¼ 12). Conclusions: For cancer patients with portomesenteric venous stenosis, transhepatic portal stenting is a safe and effective tool for palliating the adverse symptoms associated with portal hypertension.
S52
’
Sunday
Scientific Session
(66.6%). Four patients did not show improvement in their hydrothorax both clinically and radiographically (26.6%) during one-week period. Mean MELD score for patients with improvement in hydrothorax was 16.4. Mean MELD score for patients with no improvement in hydrothorax was 29. All patients with no improvement in hydrothorax had MELD scores above 20. Yet, two patients with MELD scores greater than 20 also benefited from TIPS. Greater than 5 mmHg or 37.5 % reduction (range 6-22 mmHg) in portosystemic gradient pressure was achieved in patients with improvement in hydrothorax. On the other hand, equal to or less than 5 mmHg (range 2-5 mmHg) in portosystemic pressure gradient was achieved in patients with no improvement in hydrothorax. Conclusions: Our study supports previously reported efficacy of TIPS for refractory hydrothorax. In addition, our study also suggests that less than 5 mmHg or 45% reduction in portosystemic pressure gradient and high MELD scores may predict unsuccessful short-term outcome of TIPS for refractory hydrothorax. Reference 1. Brooke E, et al. Safety and Efficacy of Transjugular Intrahepatic Portosystemic Shunt Creation for the Treatment of Hepatic Hydrothorax Spencer. J Vasc Interv Radiol 13(4):385-439.
4:21 PM
Abstract No. 108
Percutaneous transhepatic stent placement for palliation of symptomatic portal hypertension due to extrinsic extrahepatic portomesenteric venous stenosis in cancer patients P. Parmet, S. Sabir, M. Wallace; MD Anderson Cancer Center, Houston, TX
’
JVIR
Purpose: This study was performed to evaluate the efficacy of transhepatic stent placement in the palliation of cancer patients with refractory ascites and/or variceal bleeding due to extrahepatic portomesenteric venous stenosis. Materials: We retrospectively reviewed the records of 38 consecutive patients who underwent percutaneous transhepatic portal venous stenting between January 2007 and July 2015. A total of 28 patients met study inclusion criteria consisting of extrahepatic portomesenteric venous stenosis with primary indication being palliation of refractory ascites or gastrointestinal bleeding. Technical success, clinical success (initial and duration), and overall survival were evaluated. A measure we call fraction of remaining life palliated, which is duration of clinical success divided by overall survival, is reported. Additional characteristics reviewed include etiology of stenosis and morphology of stent deployment. Routine imaging surveillance for stent patency was not performed. Results: Median patient age at treatment was 60 years (range 7 – 79) with male predominance (61%). Pancreatic adenocarcinoma was the most common primary malignancy (21/28). Technical success was achieved in 93% of patients, with clinical success on initial follow up achieved in 86%. For patients successfully stented, average fraction of remaining life palliated was 0.87; and median overall survival was 358 days, including 7 patients still being followed at the time of data analysis. There were no procedure-related complications. In subgroup analysis, average fraction of remaining life palliated trended lower with narrowing due to malignant stenosis (0.86, n ¼ 22) versus post-treatment change (0.95, n ¼ 4); stent deployment crossing the portal confluence (0.81, n ¼ 18) versus single vessel deployment (0.97, n ¼ 8); and refractory ascites (0.81, n ¼ 15) versus bleeding (0.97, n ¼ 12). Conclusions: For cancer patients with portomesenteric venous stenosis, transhepatic portal stenting is a safe and effective tool for palliating the adverse symptoms associated with portal hypertension.