Portomesenteric decompression is often necessary to treat patients with refractory
symptoms of portal hypertension. When transjugular or direct intrahepatic portosystemic
shunt creation is not feasible or is inadequate, surgical portosystemic shunt creation
is considered, which carries significant morbidity and mortality in these high-risk
patients. Surgery is further complicated in patients with portomesenteric thrombosis
who require concurrent thrombectomy and long-term anticoagulation. In this article,
we outline the technique for performing advanced endovascular alternatives to intrahepatic
portosystemic shunt creation including mesocaval and splenorenal shunting. We will
also discuss some of the clinical considerations for treating these patients with
symptomatic portal hypertension and portomesenteric thrombosis.
Keywords
mesocaval shunt - splenorenal shunt - portal vein thrombosis - interventional radiology
- transjugular intrahepatic portosystemic shunt
