ARRS 2022 Abstracts

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E1282. Transhepatic Stent Placement for Malignant Portal Vein Obstruction: Long-Term Efficacy and Factors Associated With Stent Failure
Authors
  1. Chang Jin Yoon; Seoul National University Bundang Hospital
  2. Jae Hwan Lee; Seoul National University Bundang Hospital
  3. Won Seok Choi; Seoul National University Bundang Hospital
  4. Chong-ho Lee; Seoul National University Bundang Hospital
Objective:
The objective of this study was to evaluate the long-term efficacy of transhepatic stent placement in patients with symptomatic malignant portal vein (PV) obstruction and to identify risk factors for stent failure.

Materials and Methods:
From May 2009 to March 2021, transhepatic stent placement was attempted in 39 patients with symptomatic malignant PV obstruction: naïve (n = 22) or recurrent tumor after surgery (n = 17). Technical success, clinical outcomes, and complications were retrospectively evaluated. Ten clinical variables were analyzed to determine risk factors for stent failure.

Results:
A stent was successfully placed in all but one patient (97.4%, 38/39). Thrombolysis and/or thromboaspiration (n = 9) and jejunal variceal embolization (n = 5) were performed in the same session. Symptoms related to portal hypertension were resolved in 32 of the 38 (84.2%) patients. There were no procedure-related major complications. During the follow-up period (median 96 days), stent failures occurred in six patients (15.8%): five stent thromboses within 60 days and one tumor ingrowth at 741 days after stent placement. In multivariate analysis, the presence of PV thrombosis at the time of stent placement was associated with stent failure (HR 12.25; 95% CI 1.05–141.34, p = 0.04).

Conclusion:
Transhepatic stent placement is a safe and effective treatment for malignant PV obstruction; however, stent failure was not uncommon (16%) and mostly due to early stent thrombosis (< 60 days). The stent failure was associated with PV thrombosis.