Purpose or Case Report: Stenosis of the inferior vena cava or the hepatic veins is an underlying cause for hepatic compromise in liver transplant patients and in patients with inflammatory diseases of the liver, leading to considerable morbidity. CT-guided or ultrasound-guided minimally invasive vessel recanalization procedures can reverse liver failure in these patients by restoring vessel patency. However, it can be difficult to employ these techniques using traditional guidewire tips against fibrotic obstructions associated with vessels that have undergone repeated stenosis. Sharp recanalization offers an alternative strategy to gain access through these obstacles by utilizing needles or the sharp end of the guidewire tip to penetrate the vessel obstruction. This technique has been well-described and employed successfully in adult patients, but has not yet been reported in the pediatric setting.
Methods & Materials:
Results: Here, we present 3 cases of image-guided hepatic vein sharp recanalization in pediatric patients, one of whom required stent placement for recurrent venous stenotic obstructions of the inferior vena cava and hepatic veins. We were able to restore hepatic vein patency in all three patients with no acute or long-term complications. Two of the patients had undergone previous liver transplants, and in following the durability of the venous recanalization in these patients, we observed long-term extension of liver graft life to the extent of at least 18 months and 38 months, respectively.
Conclusions: To the best of our knowledge, we present the first application of sharp recanalization in pediatric patients, and demonstrate evidence that it can be used safely and effectively to restore IVC and HV patency and prolong liver function in this patient population.