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Purpose: To evaluate technical and clinical success and report long-term outcomes of portal vein (PV) recanalization in pediatric orthotopic liver transplant (OLT) patients with chronic PV occlusion.Materials and Methods: This is a retrospective review of 15 OLT patients (5 males) with chronic PV occlusion who underwent PV recanalization (33 procedures) between October 2011 and February 2018. Median age was 4.5 years (range, 1-16 years); median weight was 16.6 kg (range, 11.5-57.3 kg). Median time interval from OLT to first intervention was 3.25 years (range, 0.6-15.7 years). Clinical presentations included hypersplenism (n = 12), gastrointestinal bleeding (n = 9), and ascites (n = 3). One patient had incidental diagnosis of PV occlusion. Primary, primary-assisted, and secondary patency at 3, 6, 12, and 24 months were evaluated.Results: Technically successful PV recanalization and reduction of PV pressure gradient to ≤ 5 mm Hg was performed in 13/15 patients (87%). Ten of 15 (67%) patients had successful recanalization with the first attempt. Clinical success, defined as improvement in signs and symptoms of portal hypertension, was achieved in 12/13 (92%) patients. Five of 33 (15%) major complications (Society of Interventional Radiology class C), including perisplenic hematoma (n = 2), hemoperitoneum (n = 2), and hepatic artery pseudo aneurysm (n = 1), were managed with pain medication and blood product replacement. Median follow-up was 22 months (range, 1-77 months). Median primary patency was 5 months. Primary patency at 3, 6, 12, and 24 months was 53.8%, 46.2%, 38.5%, and 30.8%, respectively. Primary-assisted patency was 84.6%, 76.9%, 53.8%, and 46.2%, respectively. Secondary patency was 92.3%, 84.6%, 53.8%, and 46.2%, respectively.Conclusions: PV recanalization is a safe and effective minimally invasive option in the management of chronic PV occlusion after pediatric OLT. [ABSTRACT FROM AUTHOR]

Purpose: To report the results of a multicenter experience with the Viatorr expanded polytetrafluoroethylene-covered stent-graft for transjugular intrahepatic portosystemic shunt (TIPS) creation in which patency and clinical outcome were evaluated. Materials and Methods: One hundred consecutive patients with portal hypertension, with a mean age of 52 years (range, 22-86 years), underwent implantation of the Viatorr TIPS stent-graft at one of three hospital centers. The indications for TIPS creation were variceal bleeding (n = 81) and refractory ascites (n = 19). Twenty patients had Child-Pugh class A disease, 46 had class B disease, and 34 had class C disease. Eighty-seven patients underwent de novo TIPS placements, with 13 treated for recurrent TIPS stenosis. Sixty-two patients were available for follow-up portal venography and portosystemic pressure gradient (PSG) measurement commencing 6 months after Viatorr stent-graft placement. Results: The technical success rate was 100%. TIPS creation resulted in an immediate decrease in mean PSG (+/-SD) from 21 mm Hg +/- 6 to 7 mm Hg +/- 3. Acute repeat intervention (within 30 days) was required for portal vein thrombosis (n = 1), continued bleeding (n = 3), and encephalopathy (n = 1). The all-cause 30-day mortality rate was 12%. Two patients developed acute severe refractory encephalopathy, which led to death in one case. New or worsening encephalopathy was identified in 14% of patients. The incidence of recurrent bleeding was 8%. The cumulative survival rate at 1 year was 65%. Sixty-two patients available for venographic follow-up had a mean PSG of 9 mm Hg +/- 5 at a mean interval of 343 days (range, 56-967 days). There were four stent-graft occlusions (6%) and seven hemodynamically significant stenoses (11%), four within the stent-graft and three in the non-stent-implanted hepatic vein. The primary patency rate at 1 year by Kaplan-Meier analysis was 84%. Conclusions: This retrospective multicenter experience with the Viatorr stent-graft confirms the preliminary findings of other investigators of good technical results and improved patency compared with bare stents. Early mortality and symptomatic recurrence rates are low by historical standards. The theoretical increase in TIPS-related encephalopathy was not demonstrated. Longer-term follow-up will be required to determine whether the additional cost of the Viatorr stent-graft will be offset by reduced surveillance and repeat intervention. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the role of multimodality imaging tools for intraprocedural guidance and outcome evaluation during sclerotherapy of low-flow orbital vascular malformations.Materials and Methods: A retrospective review was performed of 17 consecutive patients with low-flow orbital malformations (14 lymphatic, two venous, and one venolymphatic) who underwent multimodality image-guided sclerotherapy between November 2012 and May 2015. Sclerotherapy technique, image guidance tools, and complications were recorded. Sclerotherapy outcome was evaluated using clinical response, magnetic resonance (MR) image-based lesion volumetry, and proptosis quantification.Results: There were 22 sclerotherapy sessions performed. Intraprocedural ultrasound (US), fluoroscopy, cone-beam computed tomography (CT) and MR image fusion were used for image guidance with 100% technical success. Resolution of presenting symptoms was observed in all patients at 1-month follow-up. Four major sclerotherapy complications were successfully managed. Statistically significant reduction in lesion volume (P = .001) and proptosis (P = .0117) by MR image analysis was achieved in all patients in whom 3-month follow-up MR imaging was available (n = 13/17). There was no lesion recurrence at a median follow-up of 18 months (range, 8-38 mo).Conclusions: Multimodality imaging tools, including US, fluoroscopy, cone-beam CT, and MR fusion, during sclerotherapy of low-flow orbital malformations provide intraprocedural guidance and quantitative image-based evaluation of treatment outcome. [ABSTRACT FROM AUTHOR]

Purpose: To review the long term results and complications of children who underwent BAE in a single center. Materials and Methods: We present a retrospective review of patients who underwent BAE at a tertiary care children’s hospital over the last 13 years. After obtaining IRB approval, relevant data (demographics, indication, underlying disease, clinical presentation, preoperative imaging, bronchial artery anatomy, technique, results, complications and clinical outcome) was collected and analyzed. Results: 22 procedures were performed in 19 patients (12M, 7F), 9 months-21 years age. Indication for BAE was chronic intermittent hemoptysis (5-30 cc/day) in 54% and acute hemoptysis (200-500 cc) in 46%. Etiology of hemoptysis was: cystic fibrosis (90%), congenital heart disease (5%) and no apparent cause (5%). Most patients (95%) had a preoperative chest radiograph; 67% of which lateralized disease to one lung. Other preoperative imaging included CT chest (23%), CT angiogram (23%), cardiac catheterization (4%) and bronchoscopy (14%). The latter lateralized bleeding to one lung in 67%. A non-bronchial systemic supply was seen in 50% and spinal artery in 14%. A right intercosto-bronchial trunk was seen in 50%, common bronchial trunk in 41%, and bronchial artey aneurysm in 1. The most common embolic agent was PVA particles (64%) followed by embospheres (32%). Both PVA and embospheres were used in 1, gel foam in 2 and aneurysm coil embolization in 1. The procedure was uneventful in 68% with no major or minor complications. Chest pain requiring analgesia occurred after 9% of procedures. One patient each had the following complication: groin hematoma, pericardial effusion, transient pedal ischemia, mediastinal contrast extravasation and aortic intimal dissection. The median follow-up was 54 (1-142) months. 55% of procedures were successful with complete resolution of hemoptysis and no recurrence. Recurrent bleeding occurred after 41% with 3 of these patients requiring repeat BAE at 21, 32 and 39 months, respectively. Conclusion: BAE is effective in management of acute and chronic intermittent hemoptysis in children with low risk of major complications. Recurrence is frequent and can be managed with repeat embolization. [Copyright &y& Elsevier]