Successful use of salvage portal vein stent in acute portal vein thrombosis

Background: Acute portal vein (PV) thrombosis associated with pancreatic surgery is a rare complication associated with potential catastrophic consequences. PV stenting is an option typically provided in cases of longstanding malignant PV stenosis and chronic thrombosis. We review the utility and outcomes of salvage PV stent use in acute PV thrombosis in two patients following pancreatic surgery Methods: 60-year-old female with pancreatic adenocarcinoma invasion into the porta hepatis underwent NanoKnife ablation. She developed immediate intraoperative bowel engorgement attributed to PV thrombosis. Open venorrhaphy and embolectomy could not be performed due to PV stenosis from the encroaching tumor. Successful intraoperative salvage PV stent (Bard LifeStent 4 cm x 8 mm) was deployed using direct needle access of the PV. 65-year-old male with pancreatic adenocarcinoma invasion into the PV necessitating resection of the PV with primary repair developed large volume ascites on post-operative day 3. CT scan demonstrated thickened bowel with mesenteric edema with near occlusion of the PV on duplex ultrasound. Transhepatic PV thrombectomy and stent placement (Cordis S.M.A.R.T.-Flex stent 8 cm x 12 mm) was performed successfully. Results: Both patients had recanalization of portal vein flow in the perioperative period with resolution of signs of portal hypertension. Follow up CT scans demonstrated patent PV stent at 2 months in our first patient, who died at 6 months due to progression of cancer, and at 1 year in our second patient, who continues to do well clinically. Conclusion: PV stenting is an adjunctive salvage maneuver in acute PV thrombosis in patients undergoing pancreatic tumor resection.