Longterm Outcome of Liver Transplantation for Congenital Extrahepatic Portosystemic Shunt

Abstract Background Percutaneous trans-splenic portal vein recanalization (PVR) has been reported for facilitation of transjugular intrahepatic portosystemic shunts (TIPS), however has not been applied to patients undergoing direct intrahepatic portosystemic shunt (DIPS). We report the utilization of trans-splenic-PVR with DIPS creation in a patient with chronic portal and hepatic vein occlusions undergoing liver transplantation evaluation. Case presentation A 48-year-old male with decompensated alcoholic cirrhosis complicated by refractory ascites, hepatic encephalopathy, and variceal bleeding underwent CT that demonstrated chronic occlusion of the hepatic veins (HV), extrahepatic portal vein (PV), and superior mesenteric vein (SMV). Due to failed attempts at TIPS at outside institutions, interventional radiology was consulted for portal vein recanalization (PVR) with TIPS to treat the portal hypertension and ascites and also facilitate an end-to-end PV anastomosis at transplantation. After an initial hepatic venogram confirmed chronic HV occlusion, a DIPS with trans-splenic PVR was planned. The splenic vein was accessed under sonographic guidance using a micropuncture set and subsequently upsized to a 6 French sheath over a stiff guidewire. A splenic venogram via this access confirmed occlusion of the PV with drainage of the splenic vein (SV) through gastric varices. The thrombosed PV was then recanalized and angioplastied to restore PV flow via the transsplenic approach. A transjugular liver access kit with a modified 21-gauge needle was advanced into the IVC through the internal jugular vein (IJV) sheath and directed towards the target snare in PV. The needle was used to subsequently puncture the PV through the caudate lobe and facilitate placement of a wire into the SV. The initial portosystemic gradient (PSG) was 20 mmHg. The IJV sheath was advanced through the hepatic parenchymal tract into the main-PV and a stent-graft was placed across the main PV and into the IVC. A portal venogram demonstrated brisk blood flow through the DIPS, resolution of varices and a PSG of 8 mmHg. One month after the procedure, the patient had a significant reduction in ascites and MELD-NA score. Patient is currently listed and awaiting transplantation. Conclusions In the setting of chronically occluded portal and hepatic veins, trans-splenic PVR DIPS may serve as an effective bridge to liver transplantation by facilitating an end to end portal vein anastomosis.

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Efficacy of Transjugular Intrahepatic Portosystemic Shunt to Prevent Total Portal Vein Thrombosis in Cirrhotic Patients Awaiting for Liver Transplantation

Transplantation Proceedings ◽

10.1016/j.transproceed.2012.09.050 ◽

2012 ◽

Vol 44 (9) ◽

pp. 2603-2605 ◽

Cited By ~ 25

Author(s):

D. D'Avola ◽

J.I. Bilbao ◽

G. Zozaya ◽

F. Pardo ◽

F. Rotellar ◽

...

Keyword(s):

Liver Transplantation ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Transjugular Intrahepatic Portosystemic Shunt ◽

Portosystemic Shunt ◽

Vein Thrombosis ◽

Intrahepatic Portosystemic Shunt ◽

Cirrhotic Patients

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Liver transplantation complicated by embedded transjugular intrahepatic portosystemic shunt: A new method for portal anastomosis?a surgical salvage procedure

Liver Transplantation ◽

10.1002/lt.500060203 ◽

2000 ◽

Vol 6 (2) ◽

pp. 237-238 ◽

Cited By ~ 10

Author(s):

Robert R. Hutchins ◽

David Patch ◽

Jonathan Tibballs ◽

Andrew Burroughs ◽

Brian R. Davidson

Keyword(s):

Liver Transplantation ◽

Transjugular Intrahepatic Portosystemic Shunt ◽

Portosystemic Shunt ◽

New Method ◽

Salvage Procedure ◽

Intrahepatic Portosystemic Shunt ◽

Surgical Salvage

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Chapter 23: The Transjugular Intrahepatic Portosystemic Shunt as a Prelude to and After Liver Transplantation

Portal Hypertension ◽

10.1055/b-0037-146380 ◽

2018 ◽

Keyword(s):

Liver Transplantation ◽

Transjugular Intrahepatic Portosystemic Shunt ◽

Portosystemic Shunt ◽

Intrahepatic Portosystemic Shunt

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Clinical and laboratory outcome after surgical treatment of single congenital extrahepatic portosystemic shunt using ameroid constrictor in 25 dogs

Acta Veterinaria Brno ◽

10.2754/avb202089040357 ◽

2020 ◽

Vol 89 (4) ◽

pp. 357-365

Author(s):

Andrea Nečasová ◽

Jana Lorenzová ◽

Ladislav Stehlík ◽

Pavel Proks ◽

Zita Filipejová ◽

...

Keyword(s):

Bile Acid ◽

Surgical Treatment ◽

Clinical Outcome ◽

Acid Concentration ◽

Ammonia Concentration ◽

Portosystemic Shunt ◽

Stimulation Test ◽

Bile Acid Concentration ◽

Congenital Extrahepatic Portosystemic Shunt

The objective of the study was to evaluate the clinical and laboratory outcome after the surgical treatment of a single congenital extrahepatic portosystemic shunt using an ameroid constrictor. Patient medical records were reviewed in retrospect. Data on the signalment, clinical signs, preoperative bile acid stimulation test and ammonia concentration were recorded. The surgical treatment success rate was evaluated by mortality in the perioperative and short-term postoperative period and by the long-term clinical outcome. Bile acid stimulation test and ammonia concentration were also analysed 2–3 days, 4–6 weeks, and 6–8 weeks postoperatively. No patient died in the selected periods. The long-term clinical outcome was excellent in 15 out of 20 patients, good in 3 out of 20 patients and poor in 2 out of 20 patients. Preprandial bile acid concentration was elevated in 96.00%, postprandial bile acid concentration in 100.00% and ammonia concentration in 80.95% of patients preoperatively. A significant decrease was found in postprandial bile acid and ammonia 2–3 days postoperatively and in preprandial bile acid 4–6 weeks postoperatively. A significant decrease in liver function parameters in days post operation indicates a rapid restoration of hepatic function. The surgical treatment of a single extrahepatic portosystemic shunt using an ameroid constrictor is a successful method of treatment for this type of portosystemic shunt, with as much as 75.00% of the patients having an excellent long-term clinical outcome.

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Comparison of Surgical Ligation and Endovascular Embolization in the Management of Type II Congenital Extrahepatic Portosystemic Shunt: A Retrospective Clinical Study

10.21203/rs.3.rs-184047/v1 ◽

2021 ◽

Author(s):

Jin-long Zhang ◽

Wei Dong Duan ◽

Zhu Ting Fang ◽

Mao Qiang Wang ◽

Li Cui ◽

...

Keyword(s):

Endovascular Embolization ◽

Portosystemic Shunt ◽

Type Ii ◽

Intraoperative Blood Loss ◽

Procedure Time ◽

Surgical Ligation ◽

Post Procedure ◽

Congenital Extrahepatic Portosystemic Shunt ◽

Interventional Group ◽

Surgical Group

Abstract Background: Surgical ligation and endovascular embolization have been recommended for type II congenital extrahepatic portosystemic shunt (CEPS); however, no consensus has been reached. This study was designed to compare the safety and efficacy of surgical ligation and endovascular embolization for the treatment of type II CEPS. Methods: In this retrospective study, 23 consecutive patients diagnosed with type II CEPS between March 2011 and April 2019 were divided into either a surgical group (n=13; 41.5±19.9years) or the interventional group (n =10; 44.9±19.7years). The surgical group underwent laparoscopic surgical ligation of the shunt alone or ligation of the shunt and splenic artery and/or vein. The interventional group underwent endovascular embolization using microcoils, detachable coils and vascular plug. Results: All 23 patients received a one-step shunt closure, and their clinical symptoms were significantly improved within 3 months post-procedure and without recurrence during follow-up. The serum ammonia levels in both groups decreased after the procedure and dropped to normal level at 6 to 12 months post-procedure. Compared with baseline, the portal vein diameter in interventional group increased significantly at 3-, 6-, 12-, and 36-month post-occlusion (P=0.01 for all). The procedure time was shorter in interventional group (127.0±43.2minutes) than surgical group (219.8±56.7minutes; P <0.001). The intraoperative blood loss in interventional group (32.0±62.5mL) was less than that in surgical group (238.5±396.9mL; P=0.001).Conclusion: Both surgical ligation and endovascular embolization are effective in the treatment of type II CEPS. Endovascular embolization has the advantages of shorter procedure time, and less intraoperative blood loss. The ligation of the portosystemic shunt and splenic artery and vein is feasible with apparent safety, and it could avoid a second surgical treatment.

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