Portal Vein Stenting for Malignant Obstruction: Feasibility, Safety, and Clinical Outcomes
Introduction:
Pre-hepatic portal hypertension of malignant origin can lead to severe complications such as refractory ascites or gastrointestinal bleeding, significantly impairing patients' quality of life. Available therapeutic options are mainly symptomatic and do not address the venous obstruction. Portal vein stenting represents a minimally invasive alternative, which remains poorly studied in this setting. The aim of our study was to evaluate portal stent patency, as well as clinical efficacy and safety, in patients with symptomatic malignant stenosis or occlusion of the portal system. Methods: The team conducted a retrospective cohort study including 63 consecutive patients treated between April 2004 and March 2024 at CHU l'Archet and CAL Nice for symptomatic malignant stenosis or occlusion of the portal system. All patients underwent percutaneous transhepatic portal vein stenting with uncovered self-expandable metallic stents. The primary endpoint was stent patency, defined as the interval between implantation and the occurrence of an occlusion confirmed by imaging or end of follow-up. Secondary endpoints included technical success, clinical success (improvement of portal hypertension signs), and the occurrence of adverse events, graded according to the 2017 SIR classification.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Actual)
Enrollment
Contacts and Locations
Study Locations
-
-
Alpes Maritimes
-
Nice, Alpes Maritimes, France, 06000
- CHU de Nice
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- Age ≥ 18 years.
- Presence of symptoms related to portal hypertension (e.g., refractory ascites, gastrointestinal bleeding).
- Imaging evidence of stenosis or obstruction of the portal venous system (main portal vein, superior and/or inferior mesenteric vein, spleno-mesenteric confluence, and/or splenic vein).
Exclusion Criteria:
- Obstruction or stenosis secondary to a malignant/neoplastic process.
Study Plan
How is the study designed?
Design Details
Number of groups / cohorts
Cohorts and Interventions
Group / CohortGroup / Cohort |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Patients with malignant portal vein stenosis/occlusion treated by stent
|
The intervention consisted of percutaneous transhepatic implantation of a self-expanding metallic stent in the portal vein to treat malignant symptomatic portal vein stenosis or occlusion.
Patients were selected on the basis of clinical complications related to portal hypertension, such as refractory ascites or gastrointestinal bleeding.
The procedure aimed to restore portal vein patency and reduce symptoms.
Stents of different lengths (40 mm, 60 mm, or 80 mm) were deployed depending on the anatomical extent of the obstruction.
All procedures were performed by interventional radiologists under image guidance.
Patients were subsequently followed for technical success, stent patency, clinical efficacy, and procedure-related safety.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Portal vein stent patency.
Time Frame: From stent placement until death or loss to follow-up to 110 months.
|
Stent patency was assessed using cross-sectional imaging and/or Doppler ultrasound.
|
From stent placement until death or loss to follow-up to 110 months.
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Clinical efficacy (physiological parameter) of portal vein stenting
Time Frame: From stent placement until death or loss to follow-up to 110 months.
|
Assessment was performed retrospectively using medical records, imaging studies, and follow-up endoscopy when available.
|
From stent placement until death or loss to follow-up to 110 months.
|
|
Safety of portal vein stenting.
Time Frame: From procedure date until last follow-up to 110 months and graded according to SIR 2017 classification
|
Procedure-related adverse events were retrospectively collected from medical records and classified according to the Society of Interventional Radiology (SIR) complication grading system.
Safety was assessed by recording the occurrence, type, and severity of adverse events following stent placement.
|
From procedure date until last follow-up to 110 months and graded according to SIR 2017 classification
|
|
Technical success
Time Frame: From stent placement start to completion portography (1 hour).
|
Successful stent implantation was defined as placement at the intended anatomical site with confirmed patency on completion portography.
|
From stent placement start to completion portography (1 hour).
|
Collaborators and Investigators
Sponsor
Sponsor
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- 25Radio01
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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