Endovascular flow reduction after portal vein arterialization: a technical note

Area of Science:

• Interventional Radiology
• Vascular Surgery
• Hepatology

Background:

• Portal vein arterialization (PVA) is a critical salvage procedure for hepatic and biliary perfusion when hepatic artery reconstruction is not possible.
• Excessive arterioportal inflow post-PVA can lead to serious complications, including ascites, bleeding, and hepatic dysfunction.

Purpose of the Study:

• To describe an interventional radiology approach for managing excessive arterioportal inflow after PVA.
• To evaluate the feasibility and outcomes of endovascular flow modulation techniques.

Main Methods:

• Retrospective review of patients undergoing PVA requiring endovascular flow reduction.
• Analysis of indications, timing, techniques (balloon occlusion, stent-based modulation, coil embolization), technical success, and complications.
• Classification of complications according to CIRSE standards.

Main Results:

• Nine endovascular procedures were performed in six patients for portal hyperperfusion post-PVA.
• Technical success was achieved in 7/9 procedures; clinical success in 5/9.
• Balloon occlusion served as a temporary measure, stent-based modulation for graded reduction, and coil embolization for definitive closure.

Conclusions:

• Endovascular flow modulation is a technically feasible strategy for managing post-PVA hyperperfusion.
• Complementary IR techniques, including balloon occlusion, stents, and coils, offer tailored solutions.
• Treatment selection should be individualized based on clinical presentation, timing, and hepatic tolerance.