Percutaneous Recanalization of the Portal Vein in Children with Extrahepatic Portal Vein Obstruction

To evaluate the feasibility, technical success, clinical outcomes, and safety of percutaneous portal vein recanalization (PVR) in children with extrahepatic portal vein obstruction (EHPVO).

This retrospective single-centre study included 20 consecutive paediatric patients (median age 8.86(5,9-10,9) years)who underwent 22 PVR attempts between April 2021 and January 2025. All patients presented with cavernous transformation of the portal vein confirmed by Doppler ultrasound and contrast-enhanced CT. Clinical manifestations included hypersplenism, gastrointestinal varices or bleeding and hepatopulmonary syndrome or encephalopathy. Transhepatic, transplenic, or combined approaches were used. Technical success was defined as achieving partial or complete PVR. Patients were followed by serial Doppler ultrasound and CT scans to assess vessel patency. Complications were classified according to the CIRSE system.

Technical success was achieved in 9 of 20 patients (45%). Complete portal vein recanalization was obtained in 5 patients, while partial recanalization involving only the right portal vein was achieved in 4. Median primary patency was 10,5 (1,8-18,3) months, with a primary assisted patency of 16 (1.8-26) months. No patient experienced recurrent gastrointestinal bleeding after successful recanalization. Complications included minor abdominal pain, perihepatic hematomas, bilio-portal fistulas, one intrahepatic thrombosis, and one biliary obstruction requiring hepaticojejunostomy.

Percutaneous portal vein recanalization is a feasible and minimally invasive option for paediatric patients with EHPVO, offering restoration of physiological portal flow and improvement of portal hypertension-related complications. Despite its technical complexity and need for multidisciplinary expertise, PVR may serve as an alternative to surgical approaches.