Transsplenic Splenoportography and Portal Venous Interventions in Pediatric Patients

Overview

Journal Pediatr Radiol

Specialty Pediatrics

Date 2018 May 15

PMID 29756168

Citations 4

Authors

Eric J Monroe

Ethan J Speir

C Matthew Hawkins

Giri Shivaram

Kevin S H Koo

Anne E Gill

Affiliations

Soon will be listed here.

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.

Citing Articles

Transsplenic tract closure after transsplenic portalvenous access using gelfoam-based tract plugging.

Tc M, N K, Ss Y, Fk W, Bc M, Jb H CVIR Endovasc. 2023; 6(1):37.

PMID: 37458854 PMC: 10352193. DOI: 10.1186/s42155-023-00383-w.

Safety of Percutaneous Transmesenteric and Transsplenic Access for Portosystemic Shunt Creation in Patients with Portal Vein Obstruction: Single-Center Experience and Review of Literature.

Steffen D, Najafi A, Binkert C Cardiovasc Intervent Radiol. 2023; 46(10):1401-1406.

PMID: 37311839 DOI: 10.1007/s00270-023-03484-0.

A Review of Transsplenic Access for Portal Vein Interventions.

Gayed A, Bridges P, Johnson D Semin Intervent Radiol. 2022; 39(4):441-445.

PMID: 36406030 PMC: 9671679. DOI: 10.1055/s-0042-1757319.

Direct percutaneous access to an omental vein for embolization of Roux-en-Y limb varices in a child.

Onishi Y, Shimizu H, Ogawa E, Okamoto T, Nakamoto Y Radiol Case Rep. 2022; 17(4):1143-1147.

PMID: 35169417 PMC: 8829525. DOI: 10.1016/j.radcr.2022.01.046.

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