Assessment of surgical portosystemic shunts and associated complications: The diagnostic and therapeutic role of radiologists. Issue 8 (August 2015)

• Record Type: Journal Article
• Authors: Taslakian, Bedros; Faraj, Walid; Khalife, Mohammad; Al-Kutoubi, Aghiad; El-Merhi, Fadi; Saade, Charbel; Hallal, Ali; Haydar, Ali
• Is Part Of: European journal of radiology. Volume 84:Issue 8(2015)
• Page Start: 1525
• Page End: 1539
• Publication Date: 2015-08
• Subjects: Budd–Chiari syndrome -- Portal hypertension -- Surgical portosystemic shunt -- Imaging -- Interventional radiology -- Portosystemic shunt; CT computed tomography -- EHPVO extrahepatic portal vein obstruction -- IVC inferior vena cava -- MIP maximal intensity projection -- MPR multiplanar reconstruction -- MRA magnetic resonance angiography -- MRI magnetic resonance imaging -- SPSS surgical portosystemic shunt -- SSSR side-to-side splenorenal -- TIPS transjugular intrahepatic portosystemic shunt -- US ultrasound -- VR volume-rendered reconstruction; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2015.04.021
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Portal hypertension is the pathological increase in portal venous pressure. Surgical portosystemic shunting is an accepted methods to decrease portal venous pressure. Surgical portosystemic shunts are divided into selective and nonselective. Shunt thrombosis is a serious complication, resulting in shunt dysfunction. Imaging is essential in the assessment of the shunt function and anatomy. Abstract: Surgical portosystemic shunting, the formation of a vascular connection between the portal and systemic venous circulation, has been used as a treatment to reduce portal venous pressure. Although the use of portosystemic shunt surgery in the management of portal hypertension has declined during the past decade in favour of alternative therapies, and subsequently surgeons and radiologists became less familiar with the procedure, it remains a well-established treatment. Knowledge of different types of surgical portosystemic shunts, their pathophysiology and complications will help radiologists improve communication with surgeons and enhance their understanding of the diagnostic and therapeutic role of radiology in the assessment and management of these shunts. Optimal assessment of the shunt is essential to determine its patency and allow timely intervention. Both non-invasive and invasive imaging modalities complement each other in the evaluation of surgical portosystemic shunts. Interventional radiology plays an important role in the management of complications, such as shunt thrombosis and stenosis. This article describes the various types of surgical portosystemic shunts, explains the anatomy and pathophysiology of these shunts, illustrates the pearls and pitfalls of different imaging modalities in the assessment of these shunts and demonstrates the role of radiologists in the interventional management of complications.