Meso-Rex shunt revisited: are cryopreserved arterial allografts an alternative to autologous venous conduits?

PURPOSE: Meso-Rex procedure is the surgical treatment of choice for severe portal hypertension (PHT) secondary to extrahepatic portal vein obstruction (EHPVO). Our aim was to describe our initial experience using cryopreserved arterial allografts as an alternative shunting conduit.

METHODS

Retrospective review of patients with EHPVO who underwent a Meso-Rex procedure using cryopreserved arterial allografts between January 2023 and April 2024.

RESULTS

Rex shunt surgery was performed in five of the eleven patients operated for EHPVO during this period. Arterial allografts were employed in four cases, with a mean age of 10 ± 1.2 years. The mean conduit diameter and length was 9.25 ± 3.5 and 73.5 ± 11.5 mm, respectively. With a mean follow-up of 16 ± 5 months, all patients developed shunt thrombosis secondary to calcification. Shunt flow was reestablished exclusively with percutaneous transhepatic thrombectomy and stenting in one patient. The remaining three patients required a revision surgery to remove the calcified graft: two Rex shunts were salvaged with polytetrafluoroethylene (PTFE) conduits and one was converted to a mesocaval shunt. All shunts are patent 6.5 ± 2.2 months after repermeabilization.

CONCLUSION

Although the intended use of cryopreserved arterial grafts was to avoid comorbidities associated with harvesting autologous conduits, they are not an alternative to the classic Meso-Rex procedure given the high thrombosis and reoperation rate secondary to shunt calcification.