A custom‐made percutaneous flow‐restrictor to manage a symptomatic congenital porto‐systemic shunt in an infant

Abstract

Portosystemic shunts allow splanchnic blood to bypass the liver unfiltered, and may cause serious pulmonary and cerebral dysfunction; closure is therefore recommended. In patients where the portal system is hypoplastic, closure by a staged approach with a flow reducer may be necessary. We report a new, reliable, short, and adjustable device that can be delivered through a small 8-Fr sheath.

Expert management of congenital portosystemic shunts and their complications

“…Tailor-made endovascular approaches for two-step closure may be feasible, but this approach needs to be discussed on a case-by-case basis and considered in expert centres when the benefits outweigh the risks. [58] , [59] , [60] , [61] , [62] …”

Multistage closure of a congenital extrahepatic portosystemic shunt

“…The literature on endovascular multistage closure of type II CEPS is scarce. For longer length shunts custom-made flow restrictors (Bruckheimer et al, 2013 ; Roggen et al, 2018 ) and consecutive intra shunt stent deployment and epithelization (Eroglu et al, 2004 ) have been utilized. However, to our knowledge, only one case of a shorth length multistage closure has been reported, which combined an IVC stent with a temporary TIPS (Chick et al, 2017 ).…”

Congenital Portosystemic Shunts

“…In 1 report, the authors used a ductus arteriosus device to close an extrahepatic type II shunt (side‐to‐side) successfully in a neonate (57). Another center reports designing a tailor‐made flow restrictor for occlusion of a shunt arising in a child with situs inversus and a congenital splenorenal shunt (58). Finally, the use of a double‐barrel endovascular approach to overcome both issues of size and pressure gradient may further obviate the need for open attenuation (59).…”