Treatment of refractory benign biliary stenoses in liver transplant patients by placement and retrieval of a temporary stent-graft

Work in progress

Bryan Petersen, Hans A. Timmermans, Barry Uchida, John M. Rabkin, Frederick Keller

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Purpose: To evaluate patency of refractory benign biliary strictures in liver transplant patients treated with retrievable stent-grafts. Materials and methods: Eight male liver transplant patients who ranged in age from 42 to 52 years developed nine symptomatic biliary strictures (intrahepatic left duct, 1; hilar, 2; anastomotic, 6). These strictures had recurred despite multiple previous attempts of treatment (n = 33), including angioplasty (n = 27), surgery (n = 1), atherectomy (n = 1), metallic stent (n = 1), and prolonged catheter drainage (n = 3). As an alternative method of treatment for these refractory biliary strictures, transhepatic placement of expanded polytetrafluoroethylene stent-grafts across the strictures was performed through 10-F sheaths. In total, 14 stent-grafts were placed to treat the nine lesions, and nine of these stent-grafts were subsequently retrieved through 12-16-F sheaths. Results: Stent-grafts were deployed successfully. Delayed migrations in two patients required additional stent-graft placement. One patient died of pneumonia 1 month after stent-graft placement; the remaining seven patients had stent-grafts successfully removed at 3-10 months (mean, 5.6 months). Nine intended stent-graft retrievals were performed successfully, with two requiring use of elongated forceps. Immediately after treatment, all strictures were widely patent. Five to 6 months after stent- graft removal in these seven patients, significant strictures recurred in four of eight lesions (50%). One patient underwent surgical revision. At 6-29 months (mean, 12 months) after stent-graft removal, the remaining six patients were without clinical or laboratory evidence of biliary obstruction, despite three patients with significant recurrent strictures. Conclusion: Temporary stent-graft placement for treatment of benign biliary strictures in liver transplant patients is technically feasible. Longer follow-up with larger patient series is necessary to assess effectiveness and possible broader applications.

Original languageEnglish (US)
Pages (from-to)919-929
Number of pages11
JournalJournal of Vascular and Interventional Radiology
Volume11
Issue number7
StatePublished - 2000

Fingerprint

Stents
Pathologic Constriction
Transplants
Liver
Therapeutics
Atherectomy
Polytetrafluoroethylene
Reoperation
Angioplasty
Surgical Instruments
Drainage
Pneumonia
Catheters

Keywords

  • Bile ducts, stenosis or obstruction
  • Bile ducts, stents and prostheses
  • Liver, transplantation
  • Stents and prostheses

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

@article{6827625c80b244399a6e168211b7d9dd,
title = "Treatment of refractory benign biliary stenoses in liver transplant patients by placement and retrieval of a temporary stent-graft: Work in progress",
abstract = "Purpose: To evaluate patency of refractory benign biliary strictures in liver transplant patients treated with retrievable stent-grafts. Materials and methods: Eight male liver transplant patients who ranged in age from 42 to 52 years developed nine symptomatic biliary strictures (intrahepatic left duct, 1; hilar, 2; anastomotic, 6). These strictures had recurred despite multiple previous attempts of treatment (n = 33), including angioplasty (n = 27), surgery (n = 1), atherectomy (n = 1), metallic stent (n = 1), and prolonged catheter drainage (n = 3). As an alternative method of treatment for these refractory biliary strictures, transhepatic placement of expanded polytetrafluoroethylene stent-grafts across the strictures was performed through 10-F sheaths. In total, 14 stent-grafts were placed to treat the nine lesions, and nine of these stent-grafts were subsequently retrieved through 12-16-F sheaths. Results: Stent-grafts were deployed successfully. Delayed migrations in two patients required additional stent-graft placement. One patient died of pneumonia 1 month after stent-graft placement; the remaining seven patients had stent-grafts successfully removed at 3-10 months (mean, 5.6 months). Nine intended stent-graft retrievals were performed successfully, with two requiring use of elongated forceps. Immediately after treatment, all strictures were widely patent. Five to 6 months after stent- graft removal in these seven patients, significant strictures recurred in four of eight lesions (50{\%}). One patient underwent surgical revision. At 6-29 months (mean, 12 months) after stent-graft removal, the remaining six patients were without clinical or laboratory evidence of biliary obstruction, despite three patients with significant recurrent strictures. Conclusion: Temporary stent-graft placement for treatment of benign biliary strictures in liver transplant patients is technically feasible. Longer follow-up with larger patient series is necessary to assess effectiveness and possible broader applications.",
keywords = "Bile ducts, stenosis or obstruction, Bile ducts, stents and prostheses, Liver, transplantation, Stents and prostheses",
author = "Bryan Petersen and Timmermans, {Hans A.} and Barry Uchida and Rabkin, {John M.} and Frederick Keller",
year = "2000",
language = "English (US)",
volume = "11",
pages = "919--929",
journal = "Journal of Vascular and Interventional Radiology",
issn = "1051-0443",
publisher = "Elsevier Inc.",
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TY - JOUR

T1 - Treatment of refractory benign biliary stenoses in liver transplant patients by placement and retrieval of a temporary stent-graft

T2 - Work in progress

AU - Petersen, Bryan

AU - Timmermans, Hans A.

AU - Uchida, Barry

AU - Rabkin, John M.

AU - Keller, Frederick

PY - 2000

Y1 - 2000

N2 - Purpose: To evaluate patency of refractory benign biliary strictures in liver transplant patients treated with retrievable stent-grafts. Materials and methods: Eight male liver transplant patients who ranged in age from 42 to 52 years developed nine symptomatic biliary strictures (intrahepatic left duct, 1; hilar, 2; anastomotic, 6). These strictures had recurred despite multiple previous attempts of treatment (n = 33), including angioplasty (n = 27), surgery (n = 1), atherectomy (n = 1), metallic stent (n = 1), and prolonged catheter drainage (n = 3). As an alternative method of treatment for these refractory biliary strictures, transhepatic placement of expanded polytetrafluoroethylene stent-grafts across the strictures was performed through 10-F sheaths. In total, 14 stent-grafts were placed to treat the nine lesions, and nine of these stent-grafts were subsequently retrieved through 12-16-F sheaths. Results: Stent-grafts were deployed successfully. Delayed migrations in two patients required additional stent-graft placement. One patient died of pneumonia 1 month after stent-graft placement; the remaining seven patients had stent-grafts successfully removed at 3-10 months (mean, 5.6 months). Nine intended stent-graft retrievals were performed successfully, with two requiring use of elongated forceps. Immediately after treatment, all strictures were widely patent. Five to 6 months after stent- graft removal in these seven patients, significant strictures recurred in four of eight lesions (50%). One patient underwent surgical revision. At 6-29 months (mean, 12 months) after stent-graft removal, the remaining six patients were without clinical or laboratory evidence of biliary obstruction, despite three patients with significant recurrent strictures. Conclusion: Temporary stent-graft placement for treatment of benign biliary strictures in liver transplant patients is technically feasible. Longer follow-up with larger patient series is necessary to assess effectiveness and possible broader applications.

AB - Purpose: To evaluate patency of refractory benign biliary strictures in liver transplant patients treated with retrievable stent-grafts. Materials and methods: Eight male liver transplant patients who ranged in age from 42 to 52 years developed nine symptomatic biliary strictures (intrahepatic left duct, 1; hilar, 2; anastomotic, 6). These strictures had recurred despite multiple previous attempts of treatment (n = 33), including angioplasty (n = 27), surgery (n = 1), atherectomy (n = 1), metallic stent (n = 1), and prolonged catheter drainage (n = 3). As an alternative method of treatment for these refractory biliary strictures, transhepatic placement of expanded polytetrafluoroethylene stent-grafts across the strictures was performed through 10-F sheaths. In total, 14 stent-grafts were placed to treat the nine lesions, and nine of these stent-grafts were subsequently retrieved through 12-16-F sheaths. Results: Stent-grafts were deployed successfully. Delayed migrations in two patients required additional stent-graft placement. One patient died of pneumonia 1 month after stent-graft placement; the remaining seven patients had stent-grafts successfully removed at 3-10 months (mean, 5.6 months). Nine intended stent-graft retrievals were performed successfully, with two requiring use of elongated forceps. Immediately after treatment, all strictures were widely patent. Five to 6 months after stent- graft removal in these seven patients, significant strictures recurred in four of eight lesions (50%). One patient underwent surgical revision. At 6-29 months (mean, 12 months) after stent-graft removal, the remaining six patients were without clinical or laboratory evidence of biliary obstruction, despite three patients with significant recurrent strictures. Conclusion: Temporary stent-graft placement for treatment of benign biliary strictures in liver transplant patients is technically feasible. Longer follow-up with larger patient series is necessary to assess effectiveness and possible broader applications.

KW - Bile ducts, stenosis or obstruction

KW - Bile ducts, stents and prostheses

KW - Liver, transplantation

KW - Stents and prostheses

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