Percutaneous porto-mesenteric venous endoconduit creation to restore portal venous flow

Roberto Galuppo, Merve Ozen, Chadi Diab, Malay B. Shah

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

A 64-year-old male who underwent orthotopic liver transplant for alcoholic cirrhosis complicated by portal vein (PV) thrombosis and allograft rejection requiring re-transplantation with portocaval hemitransposition. The donor PV was anastomosed to the recipient IVC with constriction of the suprahepatic IVC to divert venous flow into the liver. Seven years later, the recipient developed refractory life-limiting hepatic encephalopathy despite adequate liver function. Review of the cross-sectional imaging showed the PV in proximity from the native splenorenal shunt (SRS) with intervening liver parenchyma (Fig. 41.1). Diagnostic arteriography and venography with intravascular ultrasound evaluation of the PV and SRS (Figs. 41.2 and 41.3) was performed to assess for feasibility of creating an endovenous conduit in between these structures. Delayed arteriograms revealed small intrahepatic portal venous branches with hepatofugal flow towards the IVC. The splenomesenteric (SM) venous outflow was directed into systemic circulation via the SRS. A staged procedure consisting of an initial creation of endovenous conduit between the PV and the SRS, followed by embolization of the SRS was agreed upon during a multidisciplinary conference.

Original languageEnglish (US)
Title of host publicationExtreme IR
Subtitle of host publicationExtraordinary Cases in Interventional Radiology and Endovascular Therapies
PublisherSpringer International Publishing
Pages146-148
Number of pages3
ISBN (Electronic)9783031242519
ISBN (Print)9783031242502
DOIs
StatePublished - Jul 12 2023

Keywords

  • Interventional radiology
  • IR
  • Percutaneous
  • Portal venous flow
  • Porto-mesenteric venous endoconduit

ASJC Scopus subject areas

  • Medicine(all)

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