Interventions for portal hypertension in patients with portal vein occlusion and possible effects of a stent-graft on hepatic circulation

Sammanfattning: Symptomatic portal hypertension (PH), is often treated by transjugular intrahepatic portosystemic shunt (TIPS). Patients with PH, caused by prehepatic portal vein occlusion, require recanalization with stent or stent-graft often followed by additional TIPS. Stent-grafts used for TIPS, may occlude the outflow from the adjacent hepatic vein, potentially disturbing the circulation through the adjoining part of the liver. In paper I, results of interventional treatment in children with PH, secondary to occlusion of the portal vein were reported. Interventional treatment was feasible, but re-intervention and follow up were important for improvement of results. In paper IV, interventional radiological treatment in 24 patients with PH and occlusion of the splancnic veins was evaluated retrospectively. In the majority of cases treatment was technically successful, with subsequent improvement of symptoms. Paper II and III report results of experimental studies. Possible negative effects of hepatic vein occlusion by the stent-graft were evaluated with interventional, scintigraphic, radionuclide and histopathological methods. In the first experiment we found that arterial supply to the liver was diminished directly after hepatic vein occlusion. In the second experimental study, the outflow from the hepatic vein was evaluated directly after TIPS and re-evaluated after two weeks. Stent-grafts used for TIPS occlude the hepatic vein, but do not have prolonged circulatory effect and do not affect the liver parenchyma. In conclusion, interventional treatment of patients with PH and occlusion of splanchnic veins is feasible and use of stent-grafts for TIPS has no long-lasting negative effect on the liver circulation.