Safety and Patency of Bare-Metal Stent versus Stent Graft Placement in Patients with Extrahepatic Portal Vein Occlusion from Pancreatic and Biliary Malignancies

Abstract

Purpose: To evaluate factors contributing to technical failure in stent placement for malignant portal vein (PV) occlusion from pancreatic and biliary malignancies and compare effectiveness and safety of bare-metal stents (BMSs) and stent grafts (SGs). Materials and Methods: The study included 69 patients with malignant PV occlusion who underwent 74 stent placement procedures between January 2018 and March 2023. Clinical and laboratory parameters were compared between technical success (n = 64) and failure (n = 10) cases and between BMS (n = 48) and SG (n = 16) groups. Clinical success, stent patency, and overall survival (OS) were compared between the 2 groups. Risk factors for stent occlusion and procedure-related adverse events were evaluated. Results: Technical success rate was 86.5%. History of radiotherapy (P = .045) and longer occlusion lengths (>4 cm) (P < .001) were associated with failure. The SG group demonstrated higher clinical success (93.8% vs 64.6%, P = .021) and lower recurrence of portal hypertension-related clinical manifestations (20.0% vs 80.6%, P < .001) compared with the BMS group. Cumulative patency at 1, 3, and 6 months was higher for SG (93.8% vs 64.6%, P = .025; 92.8% vs 51.4%, P = .006; and 90.0% vs 52.2%, P = .038; respectively). Stent type (BMS vs SG) was independently associated with occlusion in multivariable analysis (hazard ratio, 4.79; 95% CI, 1.08-21.01; P = .043). OS did not differ significantly. Conclusions: Patients with history of radiotherapy and longer length of occluded PV were at higher risk of technical failure in PV stent placement. SG could contribute to a better quality of life owing to its potential benefits in clinical success and stent patency while maintaining safety.