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Transsplenic splenoportography and portal venous interventions in pediatric patients.
- Source :
-
Pediatric radiology [Pediatr Radiol] 2018 Sep; Vol. 48 (10), pp. 1441-1450. Date of Electronic Publication: 2018 May 13. - Publication Year :
- 2018
-
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.<br />Objective: To investigate the safety and utility of transsplenic splenoportography and portal venous interventions in children.<br />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.<br />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.<br />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.
- Subjects :
- Adolescent
Angioplasty methods
Child
Child, Preschool
Female
Humans
Infant
Infant, Newborn
Male
Portasystemic Shunt, Transjugular Intrahepatic
Retrospective Studies
Thrombectomy methods
Treatment Outcome
Portal Vein diagnostic imaging
Portography methods
Radiography, Interventional methods
Spleen diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1432-1998
- Volume :
- 48
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Pediatric radiology
- Publication Type :
- Academic Journal
- Accession number :
- 29756168
- Full Text :
- https://doi.org/10.1007/s00247-018-4157-1