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Transjugular Endovascular Recanalization of Splenic Vein in Patients with Regional Portal Hypertension Complicated by Gastrointestinal Bleeding

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Abstract

Purpose

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.

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References

  1. Adams DB, Mauterer DJ, Vujic IJ, Anderson MC (1990) Preoperative control of splenic artery inflow in patients with splenic venous occlusion. South Med J 83(9):1021–1024

    Article  CAS  PubMed  Google Scholar 

  2. Bernades P, Baetz A, Levy P, Belghiti J, Menu Y, Fekete F (1992) Splenic and portal venous obstruction in chronic pancreatitis. A prospective longitudinal study of a medical-surgical series of 266 patients. Dig Dis Sci 37(3):340–346

    Article  CAS  PubMed  Google Scholar 

  3. Bisharat N, Omari H, Lavi I, Raz R (2001) Risk of infection and death among post-splenectomy patients. J Infect 43(3):182–186

    Article  CAS  PubMed  Google Scholar 

  4. Cekirge SH, Weiss JP, Foster RG, McLean GK (1993) Stent placement in a splenic vein stenosis after TIPS creation. Radiology 189(1):197–198

    CAS  PubMed  Google Scholar 

  5. Crary SE, Buchanan GR (2009) Vascular complications after splenectomy for hematologic disorders. Blood 114(14):2861–2868

    Article  CAS  PubMed  Google Scholar 

  6. Koklu S, Coban S, Yuksel O, Arhan M (2007) Left-sided portal hypertension. Dig Dis Sci 52(5):1141–1149

    Article  PubMed  Google Scholar 

  7. Little AG, Moossa AR (1981) Gastrointestinal hemorrhage from left-sided portal hypertension. An unappreciated complication of pancreatitis. Am J Surg 141(1):153–158

    Article  CAS  PubMed  Google Scholar 

  8. Liu QD, Zhou NX, Zhang WZ, Wang MQ (2005) Diagnosis and management of regional portal hypertension. Chin J Dig Dis 6(2):87–92

    Article  PubMed  Google Scholar 

  9. Madsen MS, Petersen TH, Sommer H (1986) Segmental portal hypertension. Ann Surg 204(1):72–77

    Article  CAS  PubMed  Google Scholar 

  10. Moossa AR, Gadd MA (1985) Isolated splenic vein thrombosis. World J Surg 9(3):384–390

    Article  CAS  PubMed  Google Scholar 

  11. Sakorafas GH, Sarr MG, Farley DR, Farnell MB (2000) The significance of sinistral portal hypertension complicating chronic pancreatitis. Am J Surg 179(2):129–133

    Article  CAS  PubMed  Google Scholar 

  12. Senzolo M, Burra P, Cholongitas E et al (2007) The transjugular route: the key hole to the liver world. Dig Liver Dis 39(2):105–116

    Article  CAS  PubMed  Google Scholar 

  13. Stein M, Link DP (1999) Symptomatic spleno-mesenteric-portal venous thrombosis: recanalization and reconstruction with endovascular stents. J Vasc Interv Radiol 10(3):363–371

    Article  CAS  PubMed  Google Scholar 

  14. Wang L, Liu GJ, Chen YX, Dong HP, Zhang YQ, Wang LX (2010) Combined use of D-dimer and P-selectin for the diagnosis of splenic or portal vein thrombosis following splenectomy. Thromb Res 125(5):e206–e209

    Article  CAS  PubMed  Google Scholar 

  15. Weber SM, Rikkers LF (2003) Splenic vein thrombosis and gastrointestinal bleeding in chronic pancreatitis. World J Surg 27(11):1271–1274

    Article  PubMed  Google Scholar 

  16. Xu LS, Liu JH, Lin P et al (2010) Clinical features of pancreatic disease-associated portal hypertension. Nan Fang Yi Ke Da Xue Xue Bao 30(6):1234–1236

    PubMed  Google Scholar 

Download references

Acknowledgments

This paper is supported by the Natural Science Fund of China (Grant Nos. 30770984 and 81171444).

Conflict of interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Gastroenterology, West China Hospital, Sichuan University, 37# Guoxue Lane, Chengdu, 610041, Sichuan, China

    Xuefeng Luo, Ling Nie, Zhu Wang, Jiaywei Tsauo, Chengwei Tang & Xiao Li

  2. Department of Interventional Radiology, West China Hospital, Sichuan University, 37# Guoxue Lane, Chengdu, 610041, Sichuan, China

    Xuefeng Luo, Ling Nie, Zhu Wang, Jiaywei Tsauo, Chengwei Tang & Xiao Li

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  1. Xuefeng Luo
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  2. Ling Nie
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  3. Zhu Wang
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  4. Jiaywei Tsauo
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  5. Chengwei Tang
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  6. Xiao Li
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Correspondence to Xiao Li.

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Luo, X., Nie, L., Wang, Z. et al. Transjugular Endovascular Recanalization of Splenic Vein in Patients with Regional Portal Hypertension Complicated by Gastrointestinal Bleeding. Cardiovasc Intervent Radiol 37, 108–113 (2014). https://doi.org/10.1007/s00270-013-0625-z

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  • DOI: https://doi.org/10.1007/s00270-013-0625-z

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