Clinical Images: Interventional Management of Pediatric Rex Shunt Stenosis

• Published in: The Ochsner journal Vol. 17; no. 1; pp. 6 - 8
• Main Authors: Area, Corey, Kirsch, David, Gowharji, Lena
• Format: Journal Article
• Language: English
• Published: United States Ochsner Clinic Foundation Academic Center - Publishing Services 01.01.2017; the Academic Division of Ochsner Clinic Foundation
• Subjects: Abdomen; Clinical decision making; Decision making; Intervention; Liver; Medical imaging; Patients; Pediatrics; Stents; Transplants & implants; Ultrasonic imaging; Veins & arteries
• ISSN: 1524-5012

While the study by Funaki et al recommends a preference for stent placement instead of repeat venoplasty after the second episode of recurrent stenosis, their data also indicate that two-thirds of patients who received balloon venoplasty for the third time never developed restenosis. 4 HISTORY A 6-year-old female had facial telangiectasias, splenomegaly, and thrombocytopenia on routine physical examination. Sixteen weeks postoperatively, the patient was asymptomatic, and ultrasound demonstrated stent patency (Figure 4). [image omitted: see PDF] DISCUSSION Although a paucity of data regarding long-term stent patency for portal venous stenosis following meso-Rex shunt procedures is available, the Funaki et al study describes successful stent placement in 12 pediatric patients with stenotic portal veins following partial liver transplantation. 4 The average follow-up was 47 months, and at the conclusion of the study, all of the stents remained patent and none required repeat dilatation. The Funaki et al study documented an 83% long-term success rate following 2 or fewer balloon venoplasty procedures for pediatric patients with extrahepatic portal venous stenosis post liver transplant. 4 Funaki et al used these data to recommend that stent placement should be used for patients who redevelop stenosis after the second balloon venoplasty. Because of the vessel stenosis despite repeat balloon venoplasty, the decision was made to proceed with stent placement for long-term management.