REGULAR CONTENT
Final ID
651
Type
Educational Exhibit-Poster Only
Authors
R Ter-Oganesyan1, G Rapp2, P Guichet3, S Lundahl4, M Katz5, S Kulkarni6
Institutions
1University of Southern California, Glendale, CA, 2University of Southern California, Whittier, CA, 3Keck School of Medicine of USC, Los Angeles, CA, 4N/A, Dublin, OH, 5N/A, Los Angeles, CA, 6University of Southern California, Los Angeles, CA
Purpose
1. Review venous complications of pancreatitis2. Review basic principles of transhepatic portomesenteric venoplasty and stent placement3. Share institutional experience in the management of pre-hepatic portal hypertension secondary to portomesenteric venous stenosis or occlusion
Materials & Methods
Portomesenteric venous stenosis or occlusion is a well-known complication of pancreatitis and may cause abdominal pain, variceal hemorrhage, or ascites. Significant portomesenteric venous stenosis warrants urgent intervention, as it may progress to complete thrombosis and subsequent bowel infarction. This exhibit will report our institution's experience in the percutaneous treatment of symptomatic portomesenteric venous obstruction related to pancreatitis.
Results
Retrospective review from March 2014 to June 2016 yielded a total of 7 patients treated for portomesenteric obstruction due to necrotizing pancreatitis (6) or chronic pancreatitis (1). Six patients were found to have hemodynamically significant stenosis of the portal and/or superior mesenteric veins, and one patient had main portal vein occlusion. In all patients, portal access was obtained via a transhepatic approach and all lesions were successfully crossed. One patient was treated with venoplasty alone, and 6 patients were treated with venoplasty and stenting. All patients had resolution of the venous pressure gradient. In all cases a good clinical response was achieved with resolution of symptoms related to pre-hepatic portal hypertension including: pain, ascites, and bowel edema. Complications were subcapsular hematoma in two patients, one of which required right hepatic artery embolization.
Conclusions
Portomesenteric venous stenosis or occlusion may complicate chronic or acute necrotizing pancreatitis. The resultant pre-hepatic portal hypertension may lead to the development of abdominal pain, ascites, variceal hemorrhage, portal vein thrombosis, or bowel infarction. Portal and mesenteric venoplasty alone or more often with stent placement can be a safe and efficacious therapeutic option.
Final ID
651
Type
Educational Exhibit-Poster Only
Authors
R Ter-Oganesyan1, G Rapp2, P Guichet3, S Lundahl4, M Katz5, S Kulkarni6
Institutions
1University of Southern California, Glendale, CA, 2University of Southern California, Whittier, CA, 3Keck School of Medicine of USC, Los Angeles, CA, 4N/A, Dublin, OH, 5N/A, Los Angeles, CA, 6University of Southern California, Los Angeles, CA
Purpose
1. Review venous complications of pancreatitis2. Review basic principles of transhepatic portomesenteric venoplasty and stent placement3. Share institutional experience in the management of pre-hepatic portal hypertension secondary to portomesenteric venous stenosis or occlusion
Materials & Methods
Portomesenteric venous stenosis or occlusion is a well-known complication of pancreatitis and may cause abdominal pain, variceal hemorrhage, or ascites. Significant portomesenteric venous stenosis warrants urgent intervention, as it may progress to complete thrombosis and subsequent bowel infarction. This exhibit will report our institution's experience in the percutaneous treatment of symptomatic portomesenteric venous obstruction related to pancreatitis.
Results
Retrospective review from March 2014 to June 2016 yielded a total of 7 patients treated for portomesenteric obstruction due to necrotizing pancreatitis (6) or chronic pancreatitis (1). Six patients were found to have hemodynamically significant stenosis of the portal and/or superior mesenteric veins, and one patient had main portal vein occlusion. In all patients, portal access was obtained via a transhepatic approach and all lesions were successfully crossed. One patient was treated with venoplasty alone, and 6 patients were treated with venoplasty and stenting. All patients had resolution of the venous pressure gradient. In all cases a good clinical response was achieved with resolution of symptoms related to pre-hepatic portal hypertension including: pain, ascites, and bowel edema. Complications were subcapsular hematoma in two patients, one of which required right hepatic artery embolization.
Conclusions
Portomesenteric venous stenosis or occlusion may complicate chronic or acute necrotizing pancreatitis. The resultant pre-hepatic portal hypertension may lead to the development of abdominal pain, ascites, variceal hemorrhage, portal vein thrombosis, or bowel infarction. Portal and mesenteric venoplasty alone or more often with stent placement can be a safe and efficacious therapeutic option.