Technical Note on Modified Direct Intrahepatic Portocaval Shunt Targeting Different Vessels for Portal Vein Obstruction in Cirrhosis.

IF 2.8 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CardioVascular and Interventional Radiology Pub Date : 2025-01-01 Epub Date: 2024-12-11 DOI:10.1007/s00270-024-03932-5

Tangnuer Maimaitiaishan, Xiaobing Wang, Xiaojia Chen, Feng Zhou, Feng Ding, Jie Cheng, Jun Lin, Liping Chen

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引用次数: 0

Abstract

Purpose: This study aimed to explore a modified direct intrahepatic portocaval shunt (DIPS) technique as an alternative approach for patients with portal vein occlusion (PVO) and cirrhosis who were not candidates for traditional transjugular intrahepatic portosystemic shunt (TIPS) due to anatomical challenges.

Technique: Three patients with esophageal or gastric fundus variceal hemorrhage complicated by severe PVO were treated using innovative DIPS approaches. Preoperative contrast-enhanced computed tomography was employed to assess anatomical feasibility. The modified DIPS techniques involved targeting dilated varicose veins or the confluence of the superior mesenteric and splenic veins to access the inferior vena cava. For broader clinical applications, we outlined the anatomical conditions necessary for adopting the method proposed in this study. Following the puncture, portal hypertension was effectively alleviated, and bleeding was controlled. There were no obvious complications during the follow-up period.

Conclusion: Modified DIPS targeting different vessels appears to be a feasible alternative for the treatment of severe PVO when conventional TIPS by ultrasound-guided percutaneous transhepatic or transsplenic pathway and DIPS are unsuccessful. Future validation in a larger patient population is needed.

Level of evidence: Level 4, Case Series.

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针对不同血管的改良肝内门静脉直接分流术治疗肝硬化门静脉阻塞技术要点。

目的：本研究旨在探索一种改良的直接肝内门静脉分流术（DIPS）技术，作为门静脉阻塞（PVO）和肝硬化患者的替代方法，这些患者由于解剖学上的挑战而不能接受传统的经颈静脉肝内门静脉分流术（TIPS）。方法：对3例食管或胃底静脉曲张出血合并严重PVO患者采用创新的DIPS入路进行治疗。术前采用对比增强计算机断层扫描评估解剖学可行性。改良的DIPS技术包括针对扩张的静脉曲张或肠系膜上静脉和脾静脉的汇合处进入下腔静脉。为了更广泛的临床应用，我们概述了采用本研究提出的方法所需的解剖学条件。穿刺后门静脉高压症得到有效缓解，出血得到控制。随访期间无明显并发症发生。结论：超声引导下经皮经肝或经脾途径行常规TIPS和DIPS治疗不成功时，改良的针对不同血管的DIPS是治疗重度PVO的可行选择。需要在更大的患者群体中进行进一步的验证。证据级别：4级，案例系列。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

CardioVascular and Interventional Radiology 医学-核医学

CiteScore

5.50

自引率

13.80%

发文量

306

审稿时长

3-8 weeks

期刊介绍： CardioVascular and Interventional Radiology (CVIR) is the official journal of the Cardiovascular and Interventional Radiological Society of Europe, and is also the official organ of a number of additional distinguished national and international interventional radiological societies. CVIR publishes double blinded peer-reviewed original research work including clinical and laboratory investigations, technical notes, case reports, works in progress, and letters to the editor, as well as review articles, pictorial essays, editorials, and special invited submissions in the field of vascular and interventional radiology. Beside the communication of the latest research results in this field, it is also the aim of CVIR to support continuous medical education. Articles that are accepted for publication are done so with the understanding that they, or their substantive contents, have not been and will not be submitted to any other publication.