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Semin intervent Radiol 2023; 40(01): 073-078
DOI: 10.1055/s-0043-1767687
Review Article

Endovascular Alternatives to Transhepatic Shunt Creation

Ishan Sinha
1   Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
,
Daryl T. Goldman
1   Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
,
Rahul S. Patel
1   Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
,
Francis S. Nowakowski
1   Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
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Abstract

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


Publication History

Article published online:
04 May 2023

© 2023. Thieme. All rights reserved.

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