Purpose or Case Report: Portal vein thrombosis (PVT) is a major cause of pediatric portal hypertension and gastrointestinal (GI) bleeding. Recanalization with balloon angioplasty (BA) and stent placement have emerged as a minimally invasive treatment option for PVT. We sought to review the success and complication rates of transcatheter PVT therapy in pediatric patients with native liver.
Methods & Materials: IRB approved retrospective single-center review of chronic (> 3 months) PVT in native liver managed by transcatheter therapies between 4/2014-10/2019 at a tertiary pediatric center. The demographics, procedure details, technical and clinical success, complications (graded as per SIR guidelines) and follow-up were reviewed.
Results: A total of 20 patients (pts) (55% male) had a median age and weight of 7 yrs (range 1.2-21.2) and 29.3 kg (9.2–88) respectively at first intervention. Probable cause of PVT was prior UVC placement (n=9), protein C and S deficiency (n=2) or idiopathic (n=9). 12 pts presented with GI bleeding; of those without prior GI bleed, 6 had confirmed varices on endoscopy. 16 pts had splenomegaly at baseline. Transsplenic (n=13), transhepatic portal (n= 2), or combined transsplenic and transhepatic portal (n=5) access was used. Recanalization was successful in 12 pts (60%) at initial intervention, consisting of BA (n=7), stenting (n=5), and thrombectomy (n=2) in addition to BA. Complications during initial intervention included 1 large volume hemoperitoneum (SIR C), moderate volume hemoperitoneum requiring transfusion (SIR C), and 2 instances of small volume hemoperitoneum (SIR A). Of the 12 successful cases, 6 underwent re-intervention with indications including procedural completion, recurrence of GI bleeding/thrombocytopenia, stent occlusion and persistent stenosis confirmed by ultrasound imaging. Overall, a total of 35 interventions were performed in this population of 20 pts with an additional SIR F (patient mortality) complication occurring upon reintervention.
Conclusions: Transcatheter therapy for pediatric chronic PVT in the native liver is an emerging minimally invasive treatment option. Additional research is needed to determine suitable candidates and refine interventional techniques to optimize successful treatment of pediatric chronic PVT.