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Interventions for portal hypertension in patients with portal vein occlusion and possible effects of a stent-graft on hepatic circulation

Keussen, Inger LU (2007) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2007:157.
Abstract
Symptomatic portal hypertension (PH), is often treated by transjugular intrahepatic portosystemic shunt (TIPS). Patients with PH, caused by prehepatic portal vein occlusion, require recanalization with stent or stent-graft often followed by additional TIPS. Stent-grafts used for TIPS, may occlude the outflow from the adjacent hepatic vein, potentially disturbing the circulation through the adjoining part of the liver.

In paper I, results of interventional treatment in children with PH, secondary to occlusion of the portal vein were reported. Interventional treatment was feasible, but re-intervention and follow up were important for improvement of results. In paper IV, interventional radiological treatment in 24 patients with PH... (More)
Symptomatic portal hypertension (PH), is often treated by transjugular intrahepatic portosystemic shunt (TIPS). Patients with PH, caused by prehepatic portal vein occlusion, require recanalization with stent or stent-graft often followed by additional TIPS. Stent-grafts used for TIPS, may occlude the outflow from the adjacent hepatic vein, potentially disturbing the circulation through the adjoining part of the liver.

In paper I, results of interventional treatment in children with PH, secondary to occlusion of the portal vein were reported. Interventional treatment was feasible, but re-intervention and follow up were important for improvement of results. In paper IV, interventional radiological treatment in 24 patients with PH and occlusion of the splancnic veins was evaluated retrospectively. In the majority of cases treatment was technically successful, with subsequent improvement of symptoms.

Paper II and III report results of experimental studies. Possible negative effects of hepatic vein occlusion by the stent-graft were evaluated with interventional, scintigraphic, radionuclide and histopathological methods. In the first experiment we found that arterial supply to the liver was diminished directly after hepatic vein occlusion. In the second experimental study, the outflow from the hepatic vein was evaluated directly after TIPS and re-evaluated after two weeks. Stent-grafts used for TIPS occlude the hepatic vein, but do not have prolonged circulatory effect and do not affect the liver parenchyma.

In conclusion, interventional treatment of patients with PH and occlusion of splanchnic veins is feasible and use of stent-grafts for TIPS has no long-lasting negative effect on the liver circulation. (Less)
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author
supervisor
opponent
  • Professor Nyman, Rickard, Uppsala university
organization
publishing date
type
Thesis
publication status
published
subject
keywords
recanalization, TIPS, hepatic vein occlusion, children, Key words: portal vein occlusion, scintigraphy, stent, portal hypertension
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2007:157
pages
84 pages
publisher
Diagnostic Radiology, (Lund)
defense location
Rune Grubb salen, BMC, Lund
defense date
2007-12-20 09:00
ISSN
1652-8220
ISBN
978-91-85897-35-3
language
English
LU publication?
yes
id
b2282780-dafb-45e8-b113-74a46f42cb35 (old id 631567)
date added to LUP
2007-12-03 08:07:32
date last changed
2016-09-19 08:44:58
@phdthesis{b2282780-dafb-45e8-b113-74a46f42cb35,
  abstract     = {Symptomatic portal hypertension (PH), is often treated by transjugular intrahepatic portosystemic shunt (TIPS). Patients with PH, caused by prehepatic portal vein occlusion, require recanalization with stent or stent-graft often followed by additional TIPS. Stent-grafts used for TIPS, may occlude the outflow from the adjacent hepatic vein, potentially disturbing the circulation through the adjoining part of the liver. <br/><br>
In paper I, results of interventional treatment in children with PH, secondary to occlusion of the portal vein were reported. Interventional treatment was feasible, but re-intervention and follow up were important for improvement of results. In paper IV, interventional radiological treatment in 24 patients with PH and occlusion of the splancnic veins was evaluated retrospectively. In the majority of cases treatment was technically successful, with subsequent improvement of symptoms.<br/><br>
Paper II and III report results of experimental studies. Possible negative effects of hepatic vein occlusion by the stent-graft were evaluated with interventional, scintigraphic, radionuclide and histopathological methods. In the first experiment we found that arterial supply to the liver was diminished directly after hepatic vein occlusion. In the second experimental study, the outflow from the hepatic vein was evaluated directly after TIPS and re-evaluated after two weeks. Stent-grafts used for TIPS occlude the hepatic vein, but do not have prolonged circulatory effect and do not affect the liver parenchyma. <br/><br>
In conclusion, interventional treatment of patients with PH and occlusion of splanchnic veins is feasible and use of stent-grafts for TIPS has no long-lasting negative effect on the liver circulation.},
  author       = {Keussen, Inger},
  isbn         = {978-91-85897-35-3},
  issn         = {1652-8220},
  keyword      = {recanalization,TIPS,hepatic vein occlusion,children,Key words: portal vein occlusion,scintigraphy,stent,portal hypertension},
  language     = {eng},
  pages        = {84},
  publisher    = {Diagnostic Radiology, (Lund)},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {Interventions for portal hypertension in patients with portal vein occlusion and possible effects of a stent-graft on hepatic circulation},
  volume       = {2007:157},
  year         = {2007},
}