Objectives: Portal vein stenosis is a relatively rare complication after liver transplantation but has severe consequences. Our aim is to evaluate the efficacy and long-term results of the endovascular treatment methods for portal vein stenosis.
Materials and Methods: From October 2011 to January 2024, we treated 26 patients (7 female, 19 male) with portal vein stenosis using endovascular methods. Doppler ultrasound was used for initial diagnosis, considering flow rate increase over stenosis, absence of flow, or reduced anastomotic segment size (>50%). Angiography served as the gold standard, with a pressure gradient above 5 mm-Hg indicating the need for treatment. Technical success criteria were defined as less than 50% stenosis remaining and/or a pressure gradient below 5 mmHg. Transhepatic approach was used for all patients. Balloon angioplasty was initially performed, and stents were reserved for patients in the early post-operative period or those unresponsive to balloon angioplasty.
Results: The technical success rate was 100%. Mean age was 27.1 years (SD 21.9, 4 months to 63 years). Mean time from transplantation to intervention was 271 days (0-3135). Angioplasty was successful for 7 patients (26.9%). Of 19 patients who underwent stent placement 12 (46.1%) were in the early post-operative period, in other 7 (26.9%) results of angioplasty were not satisfactory, and stents were placed. Within 3 month of transplantation, 3 patients were lost due to other complications. Among the patients with stents, 2 required reintervention, resulting in the reestablishment of good portal venous flow. During the mean follow-up of 24 months (15 days-9 years), 23 patients (88%) had portal flows within normal limits.
Conclusion: Endovascular approach is a safe and effective treatment option in the management of PVS in liver transplant patients both in adult and pediatric population in the early or late period.