Portal Vein Recanalization–Transjugular Intrahepatic Portosystemic Shunt (PVR-TIPS) with superior mesenteric vein access and balloon-assisted shunt placement

Background To report the technique and outcome of ultrasound-guided percutaneous access to the superior mesenteric vein (SMV) for balloon-assisted portal vein recanalization–transjugular intrahepatic portosystemic shunt (PVR-TIPS) in a patient with chronic portal venous and splenic vein occlusion. C...

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Published inCVIR endovascular Vol. 6; no. 1; p. 33
Main Authors Dewald, Cornelia L. A., Wacker, Frank K., Maasoumy, Benjamin, Hinrichs, Jan B.
Format Journal Article
LanguageEnglish
Published Cham Springer International Publishing 08.06.2023
Springer Nature B.V
SpringerOpen
Subjects
Balloon-assisted PVR-TIPS
Case Report
Catheters
Esophagus
Hypertension
Imaging
Interventional Radiology
Medical imaging
Medicine
Medicine & Public Health
Portal vein occlusion
Portal Vein Recanalization–Transjugular Intrahepatic Portosystemic Shunt (PVR-TIPS)
Radiology
Transmesenteric access
Ultrasonic imaging
Veins & arteries
Portal vein occlusion
Balloon-assisted PVR-TIPS
Transmesenteric access
Portal Vein Recanalization–Transjugular Intrahepatic Portosystemic Shunt (PVR-TIPS)
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Summary:Background To report the technique and outcome of ultrasound-guided percutaneous access to the superior mesenteric vein (SMV) for balloon-assisted portal vein recanalization–transjugular intrahepatic portosystemic shunt (PVR-TIPS) in a patient with chronic portal venous and splenic vein occlusion. Case presentation A 51-year-old, non-cirrhotic patient with severe portal hypertension was admitted for PVR-TIPS. Neither splenic nor hepatic access was feasible due to chronic portal and splenic vein occlusion. Percutaneous ultrasound-guided direct puncture of the SMV was performed to obtain access for balloon-assisted PVR-TIPS. The transmesenteric approach in combination with a balloon puncture technique for PVR-TIPS was successful, and no immediate complications were observed post-procedure. The subsequent follow-up exams showed patent TIPS and SMV without signs of intraabdominal hemorrhage. Conclusion Percutaneous ultrasound-guided superior mesenteric vein access for balloon-assisted PVR-TIPS is a feasible option in cases where hepatic or splenic access is not.
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ISSN:2520-8934
2520-8934
DOI:10.1186/s42155-023-00379-6