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Percutaneous CT-guided superior mesenteric vein access for portal vein recanalization-transjugular intrahepatic portosystemic shunt

Portal vein recanalization-transjugular intrahepatic portosystemic shunt (PVR-TIPS) is a valuable technique in the treatment cirrhosis and portal vein (PV) thrombosis. Only a few studies have reported cases of utilizing the transmesenteric approach in the procedure's initial portal access. Here...

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Autores principales: Ghosh, Abheek, Seyoum, Nahom, Anand, Sheena, Akhter, Nabeel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9157188/
https://www.ncbi.nlm.nih.gov/pubmed/35663820
http://dx.doi.org/10.1016/j.radcr.2022.04.025
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author Ghosh, Abheek
Seyoum, Nahom
Anand, Sheena
Akhter, Nabeel
author_facet Ghosh, Abheek
Seyoum, Nahom
Anand, Sheena
Akhter, Nabeel
author_sort Ghosh, Abheek
collection PubMed
description Portal vein recanalization-transjugular intrahepatic portosystemic shunt (PVR-TIPS) is a valuable technique in the treatment cirrhosis and portal vein (PV) thrombosis. Only a few studies have reported cases of utilizing the transmesenteric approach in the procedure's initial portal access. Here, we report the successful utilization of a CT-guided percutaneous puncture of the superior mesenteric vein (SMV) for PVR-TIPS in a patient with splenic vein thrombosis. A 54-year-old male with a history of morbid obesity (BMI: 44.67), hepatitis C, NASH cirrhosis, esophageal varices, and complete PV thrombosis presented for PVR-TIPS. An initial percutaneous transplenic approach was attempted, but was aborted due to the discovery of a splenic vein thrombosis. Subsequently, the patient was brought back into the hybrid-angio CT suite, and the SMV was accessed percutaneously with a 21-gauge needle under 4D CT-guidance. A 5-Fr micropuncture sheath was then placed. Additional portal venogram confirmed PV thrombosis. Right internal jugular vein (IJV) access was then obtained, and the right hepatic vein was catheterized. A loop snare was advanced from the SMV access into the right PV. A Colapinto needle was later positioned in the right hepatic vein, and the right PV was accessed using the loop snare as a target. A wire was then advanced and captured by the snare, and brought down through the PV. The tract was dilated with a 10 mm balloon, and a Viatorr stent was deployed. Balloon embolectomy of the SMV, splenomesenteric vein, and TIPS were then performed with a CODA balloon with improvement in flow through the TIPS on final portal venogram. Portosystemic gradient was 11 mmHg initially and 10 mmHg post-TIPS. Follow-up TIPS venogram in 3 weeks showed a widely patent TIPS. CT-guided percutaneous SMV access may serve as valuable technique in PVR-TIPS when traditional modes of initial portal access for recanalization are unobtainable.
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spelling pubmed-91571882022-06-02 Percutaneous CT-guided superior mesenteric vein access for portal vein recanalization-transjugular intrahepatic portosystemic shunt Ghosh, Abheek Seyoum, Nahom Anand, Sheena Akhter, Nabeel Radiol Case Rep Case Report Portal vein recanalization-transjugular intrahepatic portosystemic shunt (PVR-TIPS) is a valuable technique in the treatment cirrhosis and portal vein (PV) thrombosis. Only a few studies have reported cases of utilizing the transmesenteric approach in the procedure's initial portal access. Here, we report the successful utilization of a CT-guided percutaneous puncture of the superior mesenteric vein (SMV) for PVR-TIPS in a patient with splenic vein thrombosis. A 54-year-old male with a history of morbid obesity (BMI: 44.67), hepatitis C, NASH cirrhosis, esophageal varices, and complete PV thrombosis presented for PVR-TIPS. An initial percutaneous transplenic approach was attempted, but was aborted due to the discovery of a splenic vein thrombosis. Subsequently, the patient was brought back into the hybrid-angio CT suite, and the SMV was accessed percutaneously with a 21-gauge needle under 4D CT-guidance. A 5-Fr micropuncture sheath was then placed. Additional portal venogram confirmed PV thrombosis. Right internal jugular vein (IJV) access was then obtained, and the right hepatic vein was catheterized. A loop snare was advanced from the SMV access into the right PV. A Colapinto needle was later positioned in the right hepatic vein, and the right PV was accessed using the loop snare as a target. A wire was then advanced and captured by the snare, and brought down through the PV. The tract was dilated with a 10 mm balloon, and a Viatorr stent was deployed. Balloon embolectomy of the SMV, splenomesenteric vein, and TIPS were then performed with a CODA balloon with improvement in flow through the TIPS on final portal venogram. Portosystemic gradient was 11 mmHg initially and 10 mmHg post-TIPS. Follow-up TIPS venogram in 3 weeks showed a widely patent TIPS. CT-guided percutaneous SMV access may serve as valuable technique in PVR-TIPS when traditional modes of initial portal access for recanalization are unobtainable. Elsevier 2022-05-28 /pmc/articles/PMC9157188/ /pubmed/35663820 http://dx.doi.org/10.1016/j.radcr.2022.04.025 Text en Published by Elsevier Inc. on behalf of University of Washington. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Ghosh, Abheek
Seyoum, Nahom
Anand, Sheena
Akhter, Nabeel
Percutaneous CT-guided superior mesenteric vein access for portal vein recanalization-transjugular intrahepatic portosystemic shunt
title Percutaneous CT-guided superior mesenteric vein access for portal vein recanalization-transjugular intrahepatic portosystemic shunt
title_full Percutaneous CT-guided superior mesenteric vein access for portal vein recanalization-transjugular intrahepatic portosystemic shunt
title_fullStr Percutaneous CT-guided superior mesenteric vein access for portal vein recanalization-transjugular intrahepatic portosystemic shunt
title_full_unstemmed Percutaneous CT-guided superior mesenteric vein access for portal vein recanalization-transjugular intrahepatic portosystemic shunt
title_short Percutaneous CT-guided superior mesenteric vein access for portal vein recanalization-transjugular intrahepatic portosystemic shunt
title_sort percutaneous ct-guided superior mesenteric vein access for portal vein recanalization-transjugular intrahepatic portosystemic shunt
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9157188/
https://www.ncbi.nlm.nih.gov/pubmed/35663820
http://dx.doi.org/10.1016/j.radcr.2022.04.025
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