Percutaneous Unilateral Biliary Metallic Stent Placement in Patients with Malignant Obstruction of the Biliary Hila and Contralateral Portal Vein Steno-Occlusion.
10.3348/kjr.2015.16.3.586
- Author:
Rak Chae SON
1
;
Dong Il GWON
;
Heung Kyu KO
;
Jong Woo KIM
;
Gi Young KO
Author Information
1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea. radgwon@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Biliary tract;
Malignancy;
Portal vein;
Stent
- MeSH:
Adult;
Aged;
Aged, 80 and over;
Biliary Tract Neoplasms/surgery;
Cholangitis/etiology;
Cholestasis/*surgery;
Female;
Hemobilia/etiology;
Humans;
Kaplan-Meier Estimate;
Liver/blood supply/pathology/surgery;
Liver Neoplasms/surgery;
Male;
Middle Aged;
Palliative Care/methods;
Polytetrafluoroethylene;
Portal Vein/pathology/*surgery;
Retinal Vein Occlusion/*surgery;
Retrospective Studies;
Stents/*adverse effects;
Treatment Outcome
- From:Korean Journal of Radiology
2015;16(3):586-592
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: To investigate the outcomes of percutaneous unilateral metallic stent placement in patients with a malignant obstruction of the biliary hila and a contralateral portal vein steno-occlusion. MATERIALS AND METHODS: Sixty patients with a malignant hilar obstruction and unilobar portal vein steno-occlusion caused by tumor invasion or preoperative portal vein embolization were enrolled in this retrospective study from October 2010 to October 2013. All patients were treated with percutaneous placement of a biliary metallic stent, including expanded polytetrafluoroethylene (ePTFE)-covered stents in 27 patients and uncovered stents in 33 patients. RESULTS: A total of 70 stents were successfully placed in 60 patients. Procedural-related minor complications, including self-limiting hemobilia (n = 2) and cholangitis (n = 4) occurred in six (10%) patients. Acute cholecystitis occurred in two patients. Successful internal drainage was achieved in 54 (90%) of the 60 patients. According to a Kaplan-Meier analysis, median survival time was 210 days (95% confidence interval [CI], 135-284 days), and median stent patency time was 133 days (95% CI, 94-171 days). No significant difference in stent patency was observed between covered and uncovered stents (p = 0.646). Stent dysfunction occurred in 16 (29.6%) of 54 patients after a mean of 159 days (range, 65-321 days). CONCLUSION: Unilateral placement of ePTFE-covered and uncovered stents in the hepatic lobe with a patent portal vein is a safe and effective method for palliative treatment of patients with a contralateral portal vein steno-occlusion caused by an advanced hilar malignancy or portal vein embolization. No significant difference in stent patency was detected between covered and uncovered metallic stents.
