Combined Access Strategies for Portal Vein Recanalization with Transjugular Intrahepatic Portosystemic Shunt in Pediatric Chronic Portal Vein Thrombosis: A Series of 3 Cases.

Portal vein recanalization (PVR) with transjugular intrahepatic portosystemic shunt (TIPS; PVR-TIPS) is an emerging endovascular option for pediatric chronic portal vein thrombosis with cavernous transformation. This report described 3 pediatric patients (11 months-11 years) who underwent successful PVR-TIPS using individualized transsplenic, transhepatic, and transjugular access strategies. Technical success was achieved in all cases, with restoration of portal venous flow, decompression of portal venous collaterals, and TIPS creation to maintain portal vein patency after recanalization. During follow-up, 2 patients developed shunt-related complications (stenosis or partial thrombosis) requiring successful reintervention, and all maintained functional shunt patency. One patient developed a hepatic arterioportal fistula that was successfully treated with endovascular embolization. These findings support PVR-TIPS as a feasible treatment option for selected pediatric patients with chronic portal vein thrombosis and complex portal venous anatomy, provided that close imaging surveillance is maintained.