Purpose: PV tumor thrombus percutaneous image guided recanalization technique by endoportal RFA and metal stent implantation is presented
Material and Methods: 44 patients underwent percutaneous endoportal RF treatment attempt. PV tributary is accessed under US in 43 and under CT guidance in 1 case; manipulation by 5 Fr diameter guiding catheter is used to conduct the guidewire across the blocked segment and portography is performed. 15 Watts power was applied for 2 minutes using bipolar endoluminal RF device (Habib™ EndoHPB, EMcision Ltd., London, UK), placed in PV blocked segment according the guidewire. The number of RF application sessions depends on tumor thrombus extent as shown on portography. After RF application self-expanding 14 mm diameter vascular stent is positioned and PV patency restoration is documented by final portography. Procedure is completed by procedure track RF ablation and/or embolisation by coil&gel-foam
Results: Procedure was completed in 36 (81.8%) cases; 6 (13.6%) cases - wire conduction failure; 2 (4.6%) cases - RF device conduction failure (finished by stenting only). Portal vein obstructed segment showed the restored blood flow in 36(94.7%) all 38 completed stenting cases as documented by postprocedure portography, follow-up Doppler and CT studies; this resulted in liver function improvement in 28 (73.7%) of stent positioning success cases. Procedure was complicated by intraperitoneal bleeding in 3 (6.9%) cases; 1 of them (2.3%) died because of polyorgan failure. Recanalized PV patency varied from 3 weeks to 22 months; in 12 cases patients underwent successful TACE procedure after PV recanalization.
Conclusions: PV thrombus percutaneous recanalization by endoportal RFA&stenting is effective and should be suggested as a possible treatment option for HCC patients with PVT.