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SIR 2025

Venous Interventions

Scientific Session

Session: Interventional Oncology 3

Outcomes of Portal and Superior Mesenteric Vein Stenting in cancer patients: An analysis of 250 stents

Tuesday, April 1, 2025
3:54 PM – 4:03 PM CT
Location: Music City Center, 207 AB
Purpose:

To evaluate safety, efficacy, and clinical outcomes following portal vein (PV) or superior mesenteric vein (SMV) stenting for treatment of cancer patients with symptomatic portal hypertension and thrombosed or stenotic PV or SMV.

Materials and Methods:

This single-center, retrospective study evaluated outcomes following stenting in cancer patients with thrombosed or stenosed PV or SMVs. Records were collected from an institutional database with procedures dating from August 2016 to September 2024. Outcomes included stent occlusion rates and overall survival (OS). A volumetric analysis of liver and splenic volumes was performed using automated deep-learning tools. A competing risk analysis was done for stent occlusion with death taken as a competing event.

Results:

A total of 231 patients underwent 249 procedures in which the PV or SMV were stented. 58% of the patient cohort were male.  The two most common cancer types were pancreatic adenocarcinoma (64%), and cholangiocarcinoma (23%). All patients received prior chemotherapy; and a subset were post-Whipple’s procedure (n=30/231, 13%) (table 1). Most stents were placed in PV (228, 92%), while the others were in the SMV (21, 8%). Tract closure was performed with coils (133,53%), coils and glue (103,41%), coils and obsidio conformable embolic (10, 4%), or with other devices (3, 2%). The cohort's median OS was 139 days (95% confidence interval: 93 days to 206 days), while there was no significant difference in OS between patients with in-stent thrombosis compared to those without (p=.84). The cumulative incidence of stent occlusion was 18% at 6 months whereas the cumulative incidence of death was 35.6% at the same time point. For a subset of patients with robust imaging follow-up (n= 65), there was a significant increase in liver volumes (p=.011) and decrease in splenic volumes (p=.0013) after the procedure. 35 patients required stent revision. There were no major complications (CTCAE 3 or greater).

Conclusion: In cancer patients, stenting of the PV and SMV is safe and  provides a significant increase in liver volume.