Successful Surgical Ligation Under Intraoperative Portal Vein Pressure Monitoring of a Large Portosystemic Shunt Presenting as an Intrapulmonary Shunt: Report of a Case

Surgery Today ◽  
2004 ◽  
Vol 34 (12) ◽  
pp. 1049-1052 ◽  
Author(s):  
Hiroshi Yagi ◽  
Yasutsugu Takada ◽  
Yasuhiro Fujimoto ◽  
Yasuhiro Ogura ◽  
Koichi Kozaki ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portosystemic Shunt ◽  
Pressure Monitoring ◽  
Intrapulmonary Shunt ◽  
Portal Vein Pressure ◽  
Surgical Ligation

scholarly journals Surgical Ligation of Extrahepatic Shunt under Guidance of Doppler Ultrasound, Portography, and Portal Pressure Monitoring

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Mitsugi Shimoda ◽  
Takayuki Shimizu ◽  
Keiichi Kubota
Keyword(s):  
Doppler Ultrasound ◽  
Portal Pressure ◽  
Vena Cava ◽  
Flow Speed ◽  
Portosystemic Shunt ◽  
Portal System ◽  
Pressure Monitoring ◽  
Portal Flow ◽  
Surgical Ligation ◽  
Disturbance Of Consciousness

A 54-year-old man with chronic hepatitis C was admitted to our hospital because of a disturbance of consciousness and hyperammonemia. Abdominal angiography revealed a portosystemic shunt between the superior mesenteric vein and inferior vena cava. Endoscopic examination showed no varix. As interventional treatment was unsuccessful, surgical ligation of the shunt was performed. After surgery, portography revealed a huge shunt. Before ligation, the portal pressure, portal flow speed, and volume at the umbilical portion were 24 H2O. 5.6 cm/s and 203 ml/min, respectively. Finally the shunt was ligated. The portal flow speed and volume increased for 14 days following surgery and then stabilized. No varices were observed postoperatively. Doppler ultrasound, portography, and portal pressure monitoring can be used to reveal haemodynamic changes in the portal system and justify surgical ligation of portosystemic shunt.

scholarly journals Transsplenic portal vein recanalization and direct intrahepatic portosystemic shunt placement to optimize liver transplantation

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Osman Ahmed ◽  
Abhijit L. Salaskar ◽  
Steven Zangan ◽  
Anjana Pillai ◽  
Talia Baker
Keyword(s):  
Liver Transplantation ◽  
Portal Vein ◽  
Splenic Vein ◽  
Portosystemic Shunt ◽  
Refractory Ascites ◽  
Hepatic Veins ◽  
Sonographic Guidance ◽  
Portosystemic Shunts ◽  
Intrahepatic Portosystemic Shunt ◽  
End To End

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.

scholarly journals MesoTIPS: Combined Approach for the Treatment of Portal Hypertension Secondary to Portal Vein Thrombosis – A Brief Report

2017 ◽  
Vol 01 (01) ◽  
pp. 20-26
Author(s):  
Abbas Chamsuddin ◽  
Lama Nazzal ◽  
Thomas Heffron ◽  
Osama Gaber ◽  
Raja Achou ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Vein Thrombosis ◽  
Intrahepatic Portosystemic Shunt ◽  
The Right ◽  
Minilaparotomy Approach ◽  
Mean Time

AbstractIntroduction: We describe a technique we call “Meso-transjugular intrahepatic portosystemic shunt (MTIPS)” for relief of portal hypertension secondary to portal vein thrombosis (PVT) using combined surgical and endovascular technique. Materials and Methods: Nine adult patients with PVT underwent transjugular intrahepatic portosystemic shunt through a combined transjugular and mesenteric approach (MTIPS), in which a peripheral mesenteric vein was exposed through a minilaparotomy approach. The right hepatic vein was accessed through a transjugular approach. Mechanical thrombectomy, thrombolysis, and angioplasty were performed when feasible to clear PVT. Results: All patients had technically successful procedures. Patients were followed up for a mean time of 13.3 months (range: 8 days to 3 years). All patients are still alive and asymptomatic. Conclusion: We conclude that MTIPS is effective for the relief of portal hypertension secondary to PVT.

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

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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