Endovascular management of portal vein obstruction in hepatobiliary cancer patients

J Surg Oncol. 2022 Mar;125(3):392-398. doi: 10.1002/jso.26713. Epub 2021 Oct 13.


Background and objectives: The purpose of this article is to describe the procedural safety, technical success, and clinical success of endovascular management of portal and mesenteric venous obstruction in patients with hepatobiliary neoplasms.

Methods: Institutional Review Board (IRB)-approved HIPAA compliant retrospective review of 21 consecutive patients with hepatobiliary malignancies who underwent endovascular portal vein recanalization and stent placement between January 2012 and March 2020. Clinical diagnoses were pancreatic cancer (n = 19), colon cancer metastatic to the liver (n = 1), and cholangiocarcinoma (n = 1). Presenting signs and symptoms included: ascites, abdominal pain, abnormal liver function tests, diarrhea, and gastrointestinal bleeding. Stent patency and patient survival are presented with Kaplan-Meier method.

Results: The technical success rate was 100%. A transhepatic approach was used in 20 cases (95.2%); trans-splenic access in one. Primary stent patency was 95.2%, 84%, and 68% at 1, 3, and 6 months, respectively. All stent occlusions were caused by tumor progression. A total of 80% of patients reported symptomatic improvement. Patient survival at 10 months was 40%. The early death rate was 4.76%. There were no bleeding complications from the percutaneous tracts.

Conclusion: Endovascular recanalization with stent placement is safe with high technical and clinical success.

Keywords: hepatobiliary; metallic; neoplasms; obstruction; portal vein; stents.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bile Duct Neoplasms / pathology*
  • Cholangiocarcinoma / pathology
  • Colonic Neoplasms / pathology
  • Endovascular Procedures*
  • Female
  • Humans
  • Liver Neoplasms / secondary*
  • Male
  • Mesenteric Veins
  • Middle Aged
  • Pancreatic Neoplasms / pathology*
  • Portal Vein*
  • Retrospective Studies
  • Stents
  • Treatment Outcome
  • Venous Thrombosis / diagnosis
  • Venous Thrombosis / etiology
  • Venous Thrombosis / surgery*