PURPOSE: To determine the safety and utility of percutaneous transhepatic portography (PTP) with intravascular ultrasonography (IVUS) for preoperative evaluation of major spleno-mesenteric-portal venous invasion by tumors of the pancreas, porta hepatis, or liver. MATERIALS AND METHODS: This is a 2-year prospective observational study including 15 consecutive patients (five men, 10 women; mean age, 63.3 y +/- 10.2) with tumors of the pancreas (n = 8), liver (n = 3), or porta hepatis (n = 4) who underwent PTP/IVUS after computed tomography indicated possible tumor invasion into a major portal radical. Transhepatic portal access was created under fluoroscopic guidance with an 8-F vascular sheath and IVUS was performed with an 8-F, 10-MHz system. When appropriate, operative exploration was performed (nine of 15) and findings were correlated with imaging data from PTP/IVUS. RESULTS: PTP/IVUS was performed successfully in all patients and good visualization of the major portal radicals was achieved. There were no complications from PTP/IVUS, which was performed as an outpatient procedure in most (n = 14) patients. PTP/IVUS provided precise anatomic data regarding the longitudinal and circumferential extent of major portal venous invasion by these tumors. There was excellent correlation between PTP/IVUS and operative findings. CONCLUSIONS: PTP/IVUS can be performed safely in a preoperative outpatient setting and accurately defines the extent of major portal venous invasion by tumors of the pancreas, porta hepatis, and liver.
PURPOSE: To determine the safety and utility of percutaneous transhepatic portography (PTP) with intravascular ultrasonography (IVUS) for preoperative evaluation of major spleno-mesenteric-portal venous invasion by tumors of the pancreas, porta hepatis, or liver. MATERIALS AND METHODS: This is a 2-year prospective observational study including 15 consecutive patients (five men, 10 women; mean age, 63.3 y +/- 10.2) with tumors of the pancreas (n = 8), liver (n = 3), or porta hepatis (n = 4) who underwent PTP/IVUS after computed tomography indicated possible tumor invasion into a major portal radical. Transhepatic portal access was created under fluoroscopic guidance with an 8-F vascular sheath and IVUS was performed with an 8-F, 10-MHz system. When appropriate, operative exploration was performed (nine of 15) and findings were correlated with imaging data from PTP/IVUS. RESULTS: PTP/IVUS was performed successfully in all patients and good visualization of the major portal radicals was achieved. There were no complications from PTP/IVUS, which was performed as an outpatient procedure in most (n = 14) patients. PTP/IVUS provided precise anatomic data regarding the longitudinal and circumferential extent of major portal venous invasion by these tumors. There was excellent correlation between PTP/IVUS and operative findings. CONCLUSIONS: PTP/IVUS can be performed safely in a preoperative outpatient setting and accurately defines the extent of major portal venous invasion by tumors of the pancreas, porta hepatis, and liver.
Authors: Nicolas C Buchs; Michael Chilcott; Pierre-Alexandre Poletti; Leo H Buhler; Philippe Morel Journal: World J Gastroenterol Date: 2010-02-21 Impact factor: 5.742
Authors: Alexandra M Roch; Michael G House; Jessica Cioffi; Eugene P Ceppa; Nicholas J Zyromski; Attila Nakeeb; C Max Schmidt Journal: J Gastrointest Surg Date: 2016-01-14 Impact factor: 3.452