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Semin intervent Radiol 2012; 29(02): 071-080
DOI: 10.1055/s-0032-1312567
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Percutaneous Portal Vein Access and Transhepatic Tract Hemostasis

Wael E. A. Saad
1   Division of Vascular Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
,
David C. Madoff
2   Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York, New York
› Author Affiliations
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Publication History

Publication Date:
14 June 2012 (online)

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Abstract

Percutaneous portal vein interventions require minimally invasive access to the portal venous system. Common approaches to the portal vein include transjugular hepatic vein to portal vein access and direct transhepatic portal vein access. A major concern of the transhepatic route is the risk of postprocedural bleeding, which is increased when patients are anticoagulated or receiving pharmaceutical thrombolytic therapy. Thus percutaneous portal vein access and subsequent closure are important technical parts of percutaneous portal vein procedures. At present, various techniques have been used for either portal access or subsequent transhepatic tract closure and hemostasis. Regardless of the method used, meticulous technique is required to achieve the overall safety and effectiveness of portal venous procedures. This article reviews the various techniques of percutaneous transhepatic portal vein access and the various closure and hemostatic methods used to reduce the risk of postprocedural bleeding.

Keywords

Liver - percutaneous - coils - glue (N-butyl cyanoacrylate) - Gelfoam - portal vein - hemostasis
 

  • References

  • 1 Schneider N, Scanga A, Stokes L, Perri R. Portal vein stenosis: a rare yet clinically important cause of delayed-onset ascites after adult deceased donor liver transplantation: two case reports. Transplant Proc 2011; 43 (10) 3829-3834
    CrossrefPubMedGoogle Scholar
  • 2 Saad WEA. Liver transplant-related vascular disease. In: Dake M, Geshwind J-F, eds. Abrams' Angiography: Interventional Radiology. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; . In press
    Google Scholar
  • 3 Saad WE, Waldman DL. Endovascular repair of vascular lesions in solid organ transplantation. In: Oriel K, Katzen BT, Rosenfield K, eds. Complications in Endovascular Therapy. New York, NY: Taylor & Francis Informa; 2006: 223-252
    Google Scholar
  • 4 González-Tutor A, Abascal F, Cerezai L, Bustamante M. Transjugular approach to treat portal vein stenosis after liver transplantation—a case report. Angiology 2000; 51 (6) 511-514
    CrossrefPubMedGoogle Scholar
  • 5 Cheng YF, Ou HY, Tsang LL , et al. Interventional percutaneous trans-splenic approach in the management of portal venous occlusion after living donor liver transplantation. Liver Transpl 2009; 15 (10) 1378-1380
    CrossrefPubMedGoogle Scholar
  • 6 McDaniel HM, Johnson M, Pescovitz MD , et al. Intraoperative placement of a Wallstent for portal vein stenosis and thrombosis after liver transplantation. Transplantation 1997; 63 (4) 607-608
    PubMedGoogle Scholar
  • 7 Woo DH, Laberge JM, Gordon RL, Wilson MW, Kerlan Jr RK. Management of portal venous complications after liver transplantation. Tech Vasc Interv Radiol 2007; 10 (3) 233-239
    CrossrefPubMedGoogle Scholar
  • 8 Ueda M, Egawa H, Ogawa K , et al. Portal vein complications in the long-term course after pediatric living donor liver transplantation. Transplant Proc 2005; 37 (2) 1138-1140
    CrossrefPubMedGoogle Scholar
  • 9 Madoff DC, Abdalla EK, Vauthey JN. Portal vein embolization in preparation for major hepatic resection: evolution of a new standard of care. Journal of vascular and interventional radiology. J Vasc Interv Radiol 2005; 16: 779-790
    CrossrefPubMedGoogle Scholar
  • 10 Kodama Y, Shimizu T, Endo H, Miyamoto N, Miyasaka K. Complications of percutaneous transhepatic portal vein embolization. J Vasc Interv Radiol 2002; 13: 1233-1237
    CrossrefPubMedGoogle Scholar
  • 11 Denys A, Bize P, Demartines N, Deschamps F, De Baere T ; Cardiovascular and Interventional Radiological Society of Europe. Quality improvement for portal vein embolization. Cardiovasc Intervent Radiol 2010; 33 (3) 452-456
    CrossrefPubMedGoogle Scholar
  • 12 Avritscher R, de Baere T, Murthy R, Deschamps F, Madoff DC. Percutaneous transhepatic portal vein embolization: rationale, technique, and outcomes. Semin Intervent Radiol 2008; 25 (2) 132-145
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Villiger P, Ryan EA, Owen R , et al. Prevention of bleeding after islet transplantation: lessons learned from a multivariate analysis of 132 cases at a single institution. Am J Transplant 2005; 5 (12) 2992-2998
    CrossrefPubMedGoogle Scholar
  • 14 Bertuzzi F, Grohavaz F, Maffi P , et al. Successful transplantation of human islets in recipients bearing a kidney graft. Diabetologia 2002; 45: 77-84
    CrossrefPubMedGoogle Scholar
  • 15 Hirshberg B, Rother KI, Digon III BJ , et al. Benefits and risks of solitary islet transplantation for type 1 diabetes using steroid-sparing immunosuppression: the National Institutes of Health experience. Diabetes Care 2003; 26 (12) 3288-3295
    CrossrefPubMedGoogle Scholar
  • 16 Ryan EA, Paty BW, Senior PA, Shapiro AM. Risks and side effects of islet transplantation. Curr Diab Rep 2004; 4 (4) 304-309
    CrossrefPubMedGoogle Scholar
  • 17 Weimar B, Rauber K, Brendel MD, Bretzel RG, Rau WS. Percutaneous transhepatic catheterization of the portal vein: a combined CT- and fluoroscopy-guided technique. Cardiovasc Intervent Radiol 1999; 22 (4) 342-344
    CrossrefPubMedGoogle Scholar
  • 18 Hering BJ, Kandaswamy R, Ansite JD , et al. Single-donor, marginal-dose islet transplantation in patients with type 1 diabetes. JAMA 2005; 293 (7) 830-835
    CrossrefPubMedGoogle Scholar
  • 19 Froud T, Yrizarry JM, Alejandro R, Ricordi C. Use of D-STAT to prevent bleeding following percutaneous transhepatic intraportal islet transplantation. Cell Transplant 2004; 13 (1) 55-59
    CrossrefPubMedGoogle Scholar
  • 20 Bucher P, Mathe Z, Bosco D , et al. Morbidity associated with intraportal islet transplantation. Transplant Proc 2004; 36 (4) 1119-1120
    CrossrefPubMedGoogle Scholar
  • 21 Barshes NR, Lee T, Goodpasture S , et al. Achievement of insulin independence via pancreatic islet transplantation using a remote isolation center: a first-year review. Transplant Proc 2004; 36 (4) 1127-1129
    CrossrefPubMedGoogle Scholar
  • 22 Venturini M, Angeli E, Maffi P , et al. Technique, complications, and therapeutic efficacy of percutaneous transplantation of human pancreatic islet cells in type 1 diabetes: the role of US. Radiology 2005; 234 (2) 617-624
    CrossrefPubMedGoogle Scholar
  • 23 Saad WEA. Hepatic techniques for accessing the biliary tract. Tech Vasc Interv Radiol 2008; 11: 21-42
    CrossrefPubMedGoogle Scholar
  • 24 Iezzi R, Pedicelli A, Pirro F , et al. Preliminary experience using N-butyl cyanoacrylate for management of bleeding after percutaneous transhepatic biliary drain placement: a technical note. Cardiovasc Intervent Radiol 2011; 34: 435-439
    CrossrefPubMedGoogle Scholar
  • 25 Cekirge S, Akhan O, Ozmen M, Saatci I, Besim A. Malignant biliary obstruction complicated by ascites: closure of the transhepatic tract with cyanoacrylate glue after placement of endoprosthesis. Cardiovasc Intervent Radiol 1997; 20: 228-231
    CrossrefPubMedGoogle Scholar
  • 26 Brothers MF, Kaufmann JC, Fox AJ, Deveikis JP. n-Butyl 2-cyanoacrylate—substitute for IBCA in interventional neuroradiology: histopathologic and polymerization time studies. AJNR Am J Neuroradiol 1989; 10 (4) 777-786
    PubMedGoogle Scholar