Diagn Interv Radiol. 2026 Feb 4. doi: 10.4274/dir.2026.263679. Online ahead of print.
ABSTRACT
PURPOSE: To evaluate the feasibility and early postprocedural hemorrhage outcomes of absorbable gelatin sponge (AGS) torpedo tract closure and to briefly describe the tract-closure method used following portal vein recanalization in pediatric native-liver extrahepatic portal vein obstruction.
METHODS: We retrospectively reviewed the cases of 18 consecutive children [11 boys, 7 girls; median age, 7 years (range, 5-12)] treated between 2020 and 2025 who underwent transsplenic and/or trans-hepatic portal vein recanalization with planned tract embolization using AGS torpedoes. The access sheath sizes were 5F and 6F, and unfractionated heparin was administered intraprocedurally in all cases. Procedures with inadvertent sheath dislodgment before embolization or intraprocedural wire perforation were excluded. The primary outcome was clinically significant access-tract hemorrhage within 24 hours, defined as a hemoglobin decrease > 2 g/dL together with an interval increase in intraperitoneal free fluid on ultrasound. Descriptive statistics were used; technical outcomes were summarized per tract and safety outcomes per patient.
RESULTS: Eighteen patients underwent embolization of 28 access tracts (13 transsplenic and 15 trans-hepatic). The median number of torpedoes used per tract was three (range, 2-4). All access tracts were successfully embolized with AGS torpedoes (28/28, 100%). No clinically significant access-tract hemorrhage occurred at either the patient (0/18) or tract level (0/28) within 24 hours after AGS embolization. Small perisplenic or perihepatic fluid collections were observed in 16 (88.9%) patients immediately after the procedure without an interval increase on follow-up ultrasound within 24 hours following the intervention.
CONCLUSION: AGS torpedo tract closure appears feasible and effective in preventing clinically significant access- tract hemorrhage after pediatric portal vein recanalization, including cases requiring dual access with introducer sheaths of up to 6F and intraprocedural anticoagulation. Prospective, large, multicenter studies using standardized hemostasis endpoints are needed to validate these preliminary findings.
CLINICAL SIGNIFICANCE: A readily available, absorbable material deployed as torpedoes can achieve controlled, layered parenchymal sealing in pediatric portal venous interventions.
PMID:41636081 | DOI:10.4274/dir.2026.263679
