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Safety of Percutaneous Transmesenteric and Transsplenic Access for Portosystemic Shunt Creation in Patients with Portal Vein Obstruction: Single-Center Experience and Review of Literature

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Abstract

Purpose

To evaluate the safety of ultrasound-guided percutaneous mesenteric vein access compared to transsplenic portal vein access for portosystemic shunt placement in patients with portal vein obstruction.

Materials and Methods

Eight patients underwent portosystemic shunt creation through either a transsplenic (n = 4) or transmesenteric (n = 4) approach. The superior or inferior mesenteric vein was percutaneously accessed under ultrasound guidance using a 21G needle and a 4F sheath. Hemostasis at the mesenteric access site was achieved with manual compression. For transsplenic access, sheath sizes between 6 and 8F were used and tract embolization with gelfoam was performed.

Results

Portosystemic shunt placement was successful in all patients. While there were no bleeding complications with transmesenteric access, hemorrhagic shock requiring splenic artery embolization occurred in one patient in which the transsplenic approach was used.

Conclusion

Ultrasound-guided mesenteric vein access seems feasible and a valid alternative to the transsplenic access in case of portal vein obstruction.

Level of Evidence Level 4, case series.

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Fig. 1
Fig. 2

Abbreviations

DEPS:

Direct extrahepatic portosystemic shunt

DIPS:

Direct intrahepatic portosystemic shunt

IMV:

Inferior mesenteric vein

IVC:

Inferior vena cava

PV:

Portal vein

PVR:

Portal vein recanalization

SMV:

Superior mesenteric vein

TIPS:

Transjugular intrahepatic portosystemic shunt

US:

Ultrasound

References

  1. Zurcher KS, Smith MV, Naidu SG, et al. Transsplenic portal system catheterization: review of current indications and techniques. Radiographics. 2022;42:1562–76. https://doi.org/10.1148/rg.220042.

    Article  PubMed  Google Scholar 

  2. Gayed A, Bridges PH, Johnson DT. A review of transsplenic access for portal vein interventions. Semin Interv Radiol. 2022;39:441–5. https://doi.org/10.1055/s-0042-1757319.

    Article  Google Scholar 

  3. Thornburg B, Desai K, Hickey R, et al. Portal vein recanalization and transjugular intrahepatic portosystemic shunt creation for chronic portal vein thrombosis: technical considerations. Tech Vasc Interv Radiol. 2016;19:52–60. https://doi.org/10.1053/j.tvir.2016.01.006.

    Article  PubMed  Google Scholar 

  4. RiChard J, Thornburg B. New techniques and devices in transjugular intrahepatic portosystemic shunt placement. Semin Interv Radiol. 2018;35:206–14. https://doi.org/10.1055/s-0038-1660800.

    Article  Google Scholar 

  5. Meine TC, Becker LS, Dewald CLA, et al. Percutaneous transsplenic balloon-assisted transjugular intrahepatic portosystemic shunt placement in patients with portal vein obliteration for portal vein recanalization: feasibility, safety and effectiveness. Cardiovasc Interv Radiol. 2022;45:696–702. https://doi.org/10.1007/s00270-021-03054-2.

    Article  CAS  Google Scholar 

  6. Pimpalwar S, Chinnadurai P, Hernandez A, et al. Trans-splenic access for portal venous interventions in children: Do benefits outweigh risks? Cardiovasc Interv Radiol. 2018;41:87–95. https://doi.org/10.1007/s00270-017-1756-4.

    Article  Google Scholar 

  7. Monroe EJ, Speir EJ, Hawkins CM, et al. Transsplenic splenoportography and portal venous interventions in pediatric patients. Pediatr Radiol. 2018;48:1441–50. https://doi.org/10.1007/s00247-018-4157-1.

    Article  PubMed  Google Scholar 

  8. Thornburg B, Desai K, Hickey R, et al. Pretransplantation portal vein recanalization and transjugular intrahepatic portosystemic shunt creation for chronic portal vein thrombosis: final analysis of a 61-patient cohort. J Vasc Interv Radiol. 2017;28:1714-1721.e2. https://doi.org/10.1016/j.jvir.2017.08.005.

    Article  PubMed  Google Scholar 

  9. Ohm J, Ko G, Sung K, et al. Safety and efficacy of transhepatic and transsplenic access for endovascular management of portal vein complications after liver transplantation. Liver Transplant. 2017;23:1133–42. https://doi.org/10.1002/lt.24737.

    Article  Google Scholar 

  10. Zhu K, Meng X, Zhou B, et al. Percutaneous transsplenic portal vein catheterization: technical procedures, safety, and clinical applications. J Vasc Interv Radiol. 2013;24:518–27. https://doi.org/10.1016/j.jvir.2012.12.028.

    Article  PubMed  Google Scholar 

  11. Chu HH, Kim H-C, Jae HJ, et al. Percutaneous transsplenic access to the portal vein for management of vascular complication in patients with chronic liver disease. Cardiovasc Interv Radiol. 2012;35:1388–95. https://doi.org/10.1007/s00270-011-0311-y.

    Article  Google Scholar 

  12. Marra P, Carbone FS, Augello L, et al. Embolisation of the parenchymal tract after percutaneous portal vein catheterization: a retrospective comparison of outcomes with different techniques in two centres. CVIR Endovasc. 2022;5:48. https://doi.org/10.1186/s42155-022-00321-2.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Entezari P, Riaz A, Thornburg B, Salem R. Percutaneous ultrasound-guided superior and inferior mesenteric vein access for portal vein recanalization-transjugular intrahepatic portosystemic shunt: a case series. Cardiovasc Interv Radiol. 2021;44:496–9. https://doi.org/10.1007/s00270-020-02713-0.

    Article  Google Scholar 

  14. Ghosh A, Seyoum N, Anand S, Akhter N. Percutaneous CT-guided superior mesenteric vein access for portal vein recanalization-transjugular intrahepatic portosystemic shunt. Radiol Case Rep. 2022;17:2603–6. https://doi.org/10.1016/j.radcr.2022.04.025.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Onishi Y, Shimizu H, Tsunoda S, et al. Direct percutaneous access to a mesenteric vein for antegrade embolization of esophageal varices: a case report. Radiol Case Rep. 2021;16:2491–5. https://doi.org/10.1016/j.radcr.2021.06.018.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Pang S, Liddell RP. Percutaneous mesocaval shunt creation using radiofrequency wire. Cardiovasc Interv Radiol. 2021;44:1665–7. https://doi.org/10.1007/s00270-021-02879-1.

    Article  Google Scholar 

  17. Farsad K, Zaman A. Percutaneous transmesenteric portal vein recanalization and transjugular direct intrahepatic portosystemic shunt creation for chronic portal vein occlusion. J Vasc Interv Radiol. 2019;30:892–3. https://doi.org/10.1016/j.jvir.2019.02.003.

    Article  PubMed  Google Scholar 

  18. Bercu ZL, Sheth SB, Noor A, et al. Percutaneous mesocaval shunt creation in a patient with chronic portal and superior mesenteric vein thrombosis. Cardiovasc Interv Radiol. 2015;38:1316–9. https://doi.org/10.1007/s00270-014-0989-8.

    Article  Google Scholar 

  19. Burke C, Taylor AG, Ring EJ, Kerlan RK. Creation of a percutaneous mesocaval shunt to control variceal bleeding in a child. Pediatr Radiol. 2013;43:1218–20. https://doi.org/10.1007/s00247-013-2643-z.

    Article  PubMed  Google Scholar 

  20. Moriarty JM, Kokabi N, Kee ST. Transvenous creation of a mesocaval shunt: report of use in the management of extrahepatic portal vein occlusion. J Vasc Interv Radiol. 2012;23:565–7. https://doi.org/10.1016/j.jvir.2011.09.023.

    Article  PubMed  Google Scholar 

  21. Nyman URO, Semba CP, Chang H, et al. Percutaneous Creation of a mesocaval shunt. J Vasc Interv Radiol. 1996;7:769–73. https://doi.org/10.1016/S1051-0443(96)70847-3.

    Article  CAS  PubMed  Google Scholar 

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland

    Dominik A. Steffen, Arash Najafi & Christoph A. Binkert

Authors
  1. Dominik A. Steffen
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  2. Arash Najafi
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  3. Christoph A. Binkert
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Corresponding author

Correspondence to Dominik A. Steffen.

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Conflict of interest

DAS has received research support from Philips Healthcare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Consent for publication was obtained for every individual person’s data included in the study.

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Steffen, D.A., Najafi, A. & Binkert, C.A. Safety of Percutaneous Transmesenteric and Transsplenic Access for Portosystemic Shunt Creation in Patients with Portal Vein Obstruction: Single-Center Experience and Review of Literature. Cardiovasc Intervent Radiol 46, 1401–1406 (2023). https://doi.org/10.1007/s00270-023-03484-0

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