Percutaneous transhepatic metallic stent placement for malignant portal vein stenosis

Background/Aims: We investigated the safety and efficacy of percutaneous transhepatic angioplasty with self-expanding metallic stent implantation to treat malignant portal vein stenosis. Methodology: Since 1995, we have performed metallic stent implantation in 7 cases of malignant portal vein stenosis (cholangioma, 3 cases; and cancer of the hepatic hilum, pancreatic cancer, metastatic liver tumor, and hepatocellular carcinoma, 1 case: each) and in 1 case of obstruction by local recurrence of a hilar tumor. In the 7 cases of portal vein stenosis, a Wallstent was implanted percutaneously transhepatically. In the case of portal vein obstruction, a Gianturco-Rosch Z stent was implanted via the ileocolic vein during laparotomy. Results: There were no complications related to stent placement, and the portal vein pressure decreased after stent implantation in all cases. The patency of the stent was documented by ultrasonography in all 7 cases of portal vein stenosis and was confirmed at autopsy in two cases. No patient treated for portal vein stenosis developed symptoms of portal hypertension. Conclusions: Percutaneous transhepatic angioplasty with stent insertion is a safe and useful treatment for malignant portal vein stenosis and preserves quality of life by preventing symptoms of portal hypertension.