Percutaneous Creation of a Mesocaval Shunt

Nyman, Ulf; Semba, Charles P.; Chang, Hsun-Hsien; Hoffman, Cheryl; Dake, Michael D.

doi:10.1016/s1051-0443(96)70847-3

Cited by 30 publications

(12 citation statements)

References 12 publications

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“…The clinical application of an intentional extrahepatic portacaval shunt was described by Nyman et al (19), who created a direct mesocaval shunt between the superior mesenteric vein and the IVC with a handmade covered stent to bridge the two venous structures. A 20-gauge needle was inserted from the anterior abdominal wall through the transverse colon, across the superior mesenteric vein, and into a vascular retrieval device placed in the IVC.…”

Section: Discussionmentioning

confidence: 99%

Transvenous Extrahepatic Portacaval Shunt: Feasibility Study in a Swine Model

Wallace¹,

Ahrar²,

Stephens

et al. 2003

Radiology

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Section: Discussionmentioning

confidence: 99%

Transvenous Extrahepatic Portacaval Shunt: Feasibility Study in a Swine Model

Wallace¹,

Ahrar²,

Stephens

et al. 2003

Radiology

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“…Initially described by Nyman, et al, 4 a total of eight cases of mesocaval shunt creation in the presence of chronic portal occlusion 4 5 6 7 8 have been reported in English publications ( Table 1 ). While mesocaval shunt creation may be offered to patients who are not surgical and/or TIPS candidates, certain anatomic requirements must be met.…”

Section: Discussionmentioning

confidence: 99%

Mesocaval Shunt Creation for Jejunal Variceal Bleeding with Chronic Portal Vein Thrombosis

et al. 2018

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The creation of transjugular intrahepatic portosystemic shunt (TIPS) is a widely performed technique to relieve portal hypertension, and to manage recurrent variceal bleeding and refractory ascites in patients where medical and/or endoscopic treatments have failed. However, portosystemic shunt creation can be challenging in the presence of chronic portal vein occlusion. In this case report, we describe a minimally invasive endovascular mesocaval shunt creation with transsplenic approach for the management of recurrent variceal bleeding in a portal hypertension patient with intra- and extrahepatic portal vein occlusion.

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“…Although operative mesocaval shunt creation using vitallium tubes was first described in 1945, 38 the first percutaneous construction of a mesocaval shunt was not reported until 1996. 39 Benefits of using mesenteric vessels as conduits to the systemic vasculature rather than a patent portal vein include maintenance of portal flow to the liver and preservation of native portal venous anatomy for subsequent liver transplantation. 40 On the contrary, patients with chronic portal vein occlusion who would not routinely be candidates for TIPS creation, barring application of endovascular recanalization techniques, may be eligible for mesocaval shunt creation in the setting of mesenteric vessel accessibility.…”

Section: Percutaneous Mesocaval Shuntsmentioning

confidence: 99%

“…40 On the contrary, patients with chronic portal vein occlusion who would not routinely be candidates for TIPS creation, barring application of endovascular recanalization techniques, may be eligible for mesocaval shunt creation in the setting of mesenteric vessel accessibility. 39 Drawbacks of the percutaneous mesocaval shunt approach include limited past performance and narrow clinical experience, as well as a challenging and potentially precarious procedural approach requiring transmesenteric, intraperitoneal vessel puncture.…”

Section: Percutaneous Mesocaval Shuntsmentioning

confidence: 99%

“…In the absence of IVUS, simultaneous transabdominal puncture of the SMV and IVC under CT guidance has been used to facilitate percutaneous mesocaval shunt construction. 39 Procedure Technical Outcomes TIPS TIPS procedural success is judged based on technical and hemodynamic parameters. Technical success is defined as successful shunt creation between a hepatic vein and intrahepatic portal vein branch, while hemodynamic success indicates PSG reduction below a selected threshold, typically 12 mm Hg.…”

Section: Percutaneous Mesocaval Shunt Creationmentioning

confidence: 99%

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Percutaneous Portosystemic Shunts: TIPS and Beyond

Casadaban

Gaba

2014

Semin intervent Radiol

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Objectives: Upon completion of this article, the reader will be able to identify the different percutaneous portosystemic shunts used for decompression of the portal venous system, identify indications, contraindications, and techniques for percutaneous shunt creation, and describe the technical outcomes of percutaneous shunt treatment in the setting of portal hypertension.Accreditation: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Tufts University School of Medicine (TUSM) and Thieme Medical Publishers, New York. TUSM is accredited by the ACCME to provide continuing medical education for physicians.Credit: Tufts University School of Medicine designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.Portosystemic shunts aim to mitigate the severe consequences of portal hypertension-including medically refractory variceal hemorrhage and intractable ascites-through decompression of the portal and mesenteric venous systems. While effective, traditional surgical portosystemic shunts-such as distal splenorenal (Warren), mesocaval, and portocaval shunts-are associated with nontrivial operative morbidity 1-3 and present limited applicability in cases of advanced liver disease, portal or mesenteric venous thrombosis, and medical comorbidity. 3-5 Recent advances in endovascular methodologies and technological improvements in interventional devices have spurred the development of minimally invasive treatment options for the relief of portal hypertension through creation of stent-lined extraanatomic conduits. These percutaneous procedures, performed in the interventional radiology (IR) suite using real-time imaging guidance, are associated with high technical success, safety, and efficacy, and have established a growing role in the treatment of portal hypertensive disease.6-8 The current article aims to review contemporary percutaneous portosystemic shunt approaches-including transjugular intrahepatic portosystemic shunts (TIPSs), direct intrahepatic portocaval shunts (DIPSs), percutaneous mesocaval shunts, and other percutaneous shunts-with a focus on procedure rationale, patient selection, interventional technique, and technical outcomes. Keywords► percutaneous ► transjugular intrahepatic portosystemic shunt ► direct intrahepatic portocaval shunt ► mesocaval shunt ► interventional radiology AbstractPercutaneous interventions for portal hypertension have been available since the 1990s. Over time, improved technology-including covered stent grafts-and clinical understanding has expanded the available procedures for percutaneous portal decompression. While transjugular intrahepatic portosystemic shunt creation is the most commonly cited percutaneous intervention, direct intrahepatic portocaval shunt and percutaneous mesocaval shunt...

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Percutaneous Creation of a Mesocaval Shunt

Cited by 30 publications

References 12 publications

Transvenous Extrahepatic Portacaval Shunt: Feasibility Study in a Swine Model

Transvenous Extrahepatic Portacaval Shunt: Feasibility Study in a Swine Model

Mesocaval Shunt Creation for Jejunal Variceal Bleeding with Chronic Portal Vein Thrombosis

Percutaneous Portosystemic Shunts: TIPS and Beyond

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