Abstract
Interventional radiology treatment plays a very important role in the management of portal vein (PV) complications after liver transplantation. The factors underlying PV complications include 1) decreased PV inflow, 2) the presence of portosystemic shunts, 3) traction on anastomosis, 4) tension in the interposition graft, 5) difference in caliber between smaller recipient PV and larger donor PV, 6) twisting or kinking of the vascular conduit, and 7) prior splenectomy. PV complications occur more frequently in segmental liver transplantation than in whole liver transplantation. The incidence is relatively high in pediatric recipients. Diagnosis of PV stenosis is clinically suggested by the presence of ascites, diarrhea, gastrointestinal varices and splenomegaly, and confirmed by Doppler ultrasonography.
Balloon venoplasty or stent placement for PV stenosis is performed by percutaneous transhepatic approach or transileocolic approach, and their initial technical success rate is high. Balloon venoplasty is very effective, but recurrent stenosis may occur and repeated procedures are sometimes required in patients who have undergone only balloon venoplasty. Stent placement is also effective and its recurrence rate is very low. It should be especially performed for balloon-resistant and elastic stenosis. However, long-term patency is unknown and indications for pediatric patients are not established yet. Anti-coagulant therapy during and after the procedure is also important.
