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Semin intervent Radiol
DOI: 10.1055/s-0045-1810053
Review Article

Pediatric Portal Hypertension Interventions: Ectopic Varices, Portal Vein Recanalization, Portosystemic Shunt Creation, and Maintenance of Surgical Shunts

Ronnie AlRamahi
1   Vascular and Interventional Radiology, Department of Radiology, University of Wisconsin, Madison, Wisconsin
,
Paolo Marra
2   Department of Radiology, School of Medicine and Surgery, University of Milano-Bicocca, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
,
Rush H. Chewning
3   Division of Interventional Radiology, Rady Children's Hospital, San Diego, California
,
David S. Shin
4   Division of Interventional Radiology, Department of Radiology, University of Southern California, Los Angeles, California
,
Jeffrey F. B. Chick
4   Division of Interventional Radiology, Department of Radiology, University of Southern California, Los Angeles, California
,
Eric J. Monroe
1   Vascular and Interventional Radiology, Department of Radiology, University of Wisconsin, Madison, Wisconsin
› Author Affiliations
Funding None.
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Abstract

Management of portal hypertension (PHTN) in pediatric patients presents challenges due to the smaller anatomy and a lack of standardized protocols. While evidence for endovascular management of ectopic varices, maintenance of surgical shunts, portal venous recanalization, and percutaneous portosystemic shunt creation in children grows, adaptation requires specialized techniques and equipment. This review explores the etiologies of pediatric PHTN, including Budd–Chiari syndrome, congenital anomalies, extrahepatic portal vein obstruction, and transplant vascular occlusions, and examines radiologic interventions to address these conditions. Management strategies are divided into relieving the primary cause of PHTN at the level of portal obstruction and managing the secondary effects of PHTN. For each category, the discussion focuses on device selection, postprocedural care, imaging surveillance, and management of pediatric scenarios.

Keywords

portal hypertension - portal vein - pediatric - interventional radiology - shunt - transplantation

Ethics Approval and Consent to Participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


Consent for Publication

This study was not Institutional Review Board-approved.


Authors' Contributions

All authors contributed equally to the preparation of this study.




Publication History

Article published online:
11 July 2025

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