Cardiovascular and interventional radiology · 2026
Transmesenteric Extrahepatic Portosystemic Shunt for Cavernous Transformation of Portal Vein with Superior Mesenteric Vein Occlusion.
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Li Wenhao, Zhang Heng, Mu Kerun, Li Weixiao, Cui Mingzhe, Zhai Shuiting, Tian Kun, Qin Tao
Аннотация
PURPOSE: To evaluate the feasibility, safety, and clinical efficacy of transmesenteric extrahepatic portosystemic shunt in patients with cavernous transformation of the portal vein complicated by superior mesenteric vein occlusion.
MATERIALS AND METHODS: Twenty-one consecutive patients underwent transmesenteric extrahepatic portosystemic shunt, including 13 men (62%), with a median age of 50 years (interquartile range, 43.5-56.5 years). As a hybrid procedure, the superior mesenteric vein was accessed through a mini-laparotomy and recanalized when feasible. A direct extrahepatic portosystemic shunt was then created by puncturing the inferior vena cava, and mechanical thrombectomy with catheter-directed thrombolysis was performed for recent thrombus when indicated. Technical success, clinical outcomes, complications, and stent patency were systematically evaluated during follow up.
RESULTS: The technical success rate of transmesenteric extrahepatic portosystemic shunt was 95.2% (20/21). The balloon assisted puncture technique achieved a 100% success rate (20/20), with successful puncture on the first attempt in 85% of patients (17/20). The mean superior mesenteric vein pressure significantly decreased from 29.9 ± 5.92 mmHg to 17.5 ± 2.50 mmHg (p = 0.003). No intra-abdominal hemorrhage occurred. The median follow-up duration was 18 months (interquartile range, 11-30 months). At 48 months, the cumulative stent patency rate was 75%, and the overall survival rate was 89.6%.
CONCLUSION: Transmesenteric extrahepatic portosystemic shunt may represent a complementary extrahepatic shunting option for carefully selected patients with cavernous transformation of the portal vein and extensive mesenteric venous occlusion, particularly when conventional intrahepatic shunt techniques are technically unfeasible or associated with high procedural risk.
MATERIALS AND METHODS: Twenty-one consecutive patients underwent transmesenteric extrahepatic portosystemic shunt, including 13 men (62%), with a median age of 50 years (interquartile range, 43.5-56.5 years). As a hybrid procedure, the superior mesenteric vein was accessed through a mini-laparotomy and recanalized when feasible. A direct extrahepatic portosystemic shunt was then created by puncturing the inferior vena cava, and mechanical thrombectomy with catheter-directed thrombolysis was performed for recent thrombus when indicated. Technical success, clinical outcomes, complications, and stent patency were systematically evaluated during follow up.
RESULTS: The technical success rate of transmesenteric extrahepatic portosystemic shunt was 95.2% (20/21). The balloon assisted puncture technique achieved a 100% success rate (20/20), with successful puncture on the first attempt in 85% of patients (17/20). The mean superior mesenteric vein pressure significantly decreased from 29.9 ± 5.92 mmHg to 17.5 ± 2.50 mmHg (p = 0.003). No intra-abdominal hemorrhage occurred. The median follow-up duration was 18 months (interquartile range, 11-30 months). At 48 months, the cumulative stent patency rate was 75%, and the overall survival rate was 89.6%.
CONCLUSION: Transmesenteric extrahepatic portosystemic shunt may represent a complementary extrahepatic shunting option for carefully selected patients with cavernous transformation of the portal vein and extensive mesenteric venous occlusion, particularly when conventional intrahepatic shunt techniques are technically unfeasible or associated with high procedural risk.