nach oben

Pediatric Radiology

Erschienen in:

13.05.2018 | Original Article

Transsplenic splenoportography and portal venous interventions in pediatric patients

verfasst von: Eric J. Monroe, Ethan J. Speir, C. Matthew Hawkins, Giri Shivaram, Kevin S. H. Koo, Anne E. Gill

Erschienen in: Pediatric Radiology | Ausgabe 10/2018

Einloggen, um Zugang zu erhalten

Abstract

Background

Data regarding transsplenic portal venous access for diagnostic imaging and endovascular intervention in children are limited, possibly due to concerns regarding high bleeding risks and resultant underutilization.

Objective

To investigate the safety and utility of transsplenic splenoportography and portal venous interventions in children.

Materials and methods

A retrospective review was performed of all pediatric patients undergoing percutaneous transsplenic portal venous access and intervention at two large tertiary pediatric institutions between January 2012 and April 2017 was performed. Parameters assessed included procedural indications, procedural and relevant prior imaging, technical details of the procedures, laboratory values and clinical follow-up.

Results

Transsplenic portal venous access was achieved in all patients. Diagnostic transsplenic splenoportography was performed in 22 patients and was 100% successful at providing the desired anatomical and functional information. Four transsplenic portal venous interventions were performed with 100% success: meso-Rex shunt angioplasty, snare targeted transjugular intrahepatic portosystemic shunt (TIPS) creation through cavernous transformation, pharmacomechanical thrombectomy for acute thrombosis, and transplant portal vein angioplasty. Intraperitoneal bleeding occurred in 2/26 (7.7%) and one case required transfusion (3.8%). No cases of hemorrhage were observed when transsplenic access size was 4 Fr or smaller.

Conclusion

Transsplenic splenoportography in children is safe and effective when noninvasive imaging methods have yielded incomplete information. Additionally, a transsplenic approach has advantages for complex portal interventions. Bleeding risks are proportional to tract access size and may be mitigated by tract embolization.

Rosch J, Dotter CT (1971) Extrahepatic portal obstruction in childhood and its angiographic diagnosis. AJR Am J Roentgenol 112:143–149CrossRef

Foster JH, Conkle DM, Crane JM, Bruko H (1974) Splenoportography: an assessment of its value and risk. Ann Surg 179:773

Caridi JG, Hawkins IF Jr, Cho K et al (2003) CO2 splenoportography: preliminary results. AJR Am J Roentgenol 180:1375–1378CrossRefPubMed

Liang HL, Yang CF, Pan HB et al (1997) Percutaneous transsplenic catheterization of the portal venous system. Acta Radiol 38:292–295CrossRefPubMed

Zhu K, Meng X, Zhou B et al (2013) Percutaneous transsplenic portal vein catheterization: technical procedures, safety, and clinical applications. J Vasc Interv Radiol 24:518–527CrossRefPubMed

Gong GQ, Wang XL, Wang JH et al (2001) Percutaneous transsplenic embolization of esophageal and gastrio-fundal varices in 18 patients. World J Gastroenterol 7:880CrossRefPubMedPubMedCentral

Tuite DJ, Rehman J, Davies MH et al (2007) Percutaneous transsplenic access in the management of bleeding varices from chronic portal vein thrombosis. J Vasc Interv Radiol 18:1571–1575CrossRefPubMed

Chu HH, Kim HC, Jae HJ et al (2012) Percutaneous transsplenic access to the portal vein for management of vascular complication in patients with chronic liver disease. Cardiovasc Interv Radiol 35:1388–1395CrossRef

Habib A, Desai K, Hickey R et al (2015) Portal vein recanalization–transjugular intrahepatic portosystemic shunt using the transsplenic approach to achieve transplant candidacy in patients with chronic portal vein thrombosis. J Vasc Interv Radiol 26:499–506CrossRefPubMed

10.

Rasinska G, Wermenski K, Rajszys P (1987) Percutaneous transsplenic embolization of esophageal varices in a 5-year-old child. Acta Radiol 28:299–301CrossRefPubMed

11.

Bertram H, Pfister ED, Becker T, Schoof S (2010) Transsplenic endovascular therapy of portal vein stenosis and subsequent complete portal vein thrombosis in a 2-year-old child. J Vasc Interv Radiol 21:1760–1764

12.

Chick JFB, Jo A, Dasika N et al (2017) Transsplenic endovascular recanalization and stenting of a completely occluded portal vein with jejunal variceal embolization in a pediatric liver transplant recipient. Pediatr Radiol 47:1012–1015CrossRefPubMed

13.

Pimpalwar S, Chinnadurai P, Hernandez A et al (2017) Trans-splenic access for portal venous interventions in children: do benefits outweigh risks? Cardiovasc Interv Radiol 41:87–95CrossRef

14.

Lungren MP, Lindquester WS, Seidel FG et al (2016) Ultrasound-guided liver biopsy with gelatin sponge pledget tract embolization in infants weighing less than 10 kg. J Pediatr Gastroenterol Nutr 63:e147–e151CrossRefPubMed

15.

Omary RA, Bettmann MA, Cardella JF et al (2003) Quality improvement guidelines for the reporting and archiving of interventional radiology procedures. J Vasc Interv Radiol 14:S293–S295CrossRefPubMed

16.

Uller W, Müller-Wille R, Grothues D et al (2014) Gelfoam for closure of large percutaneous transhepatic and transsplenic puncture tracts in pediatric patients. Röfo 186:693–697PubMed

17.

Robbins KA, Keet CA (2015) Intraoperative anaphylaxis likely due to Gelfoam in a pediatric patient undergoing liver biopsy. Ann Allergy Asthma Immunol 114:531–533CrossRefPubMed

18.

Dollinger M, Goessmann H, Mueller-Wille R (2014) Percutaneous transhepatic and transsplenic portal vein access: embolization of the puncture tract using amplatzer vascular plugs. Röfo 186:142–150PubMed

Titel: Transsplenic splenoportography and portal venous interventions in pediatric patients
verfasst von: Eric J. Monroe
Ethan J. Speir
C. Matthew Hawkins
Giri Shivaram
Kevin S. H. Koo
Anne E. Gill
Publikationsdatum: 13.05.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Radiology / Ausgabe 10/2018
Print ISSN: 0301-0449
Elektronische ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-018-4157-1

Neu im Fachgebiet Radiologie

18.04.2024 | Pädiatrische Notfallmedizin | Nachrichten

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Transsplenic splenoportography and portal venous interventions in pediatric patients

Abstract

Background

Objective

Materials and methods

Results

Conclusion

Neu im Fachgebiet Radiologie

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

„Nur wer sich gut aufgehoben fühlt, kann auch für Patientensicherheit sorgen“

Wie toxische Männlichkeit der Gesundheit von Männern schadet

Studie bestätigt Potenzial von KI in der Radiologie

Update Radiologie

Springer Medizin

Abstract

Background

Objective

Materials and methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 10/2018

Teaching and learning in the millennial age

What it means ‘to teach’ as a radiologist in the modern era: a personal perspective

Constant inhibition in congenital lower extremity shortening: does it begin in utero?

Documenting your career as an educator electronically

Designing and testing an educational innovation

Learning, teaching and writing with reference managers

Neu im Fachgebiet Radiologie

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

„Nur wer sich gut aufgehoben fühlt, kann auch für Patientensicherheit sorgen“

Wie toxische Männlichkeit der Gesundheit von Männern schadet

Studie bestätigt Potenzial von KI in der Radiologie

Update Radiologie