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Purpose <p>To evaluate the feasibility, safety, and clinical efficacy of transmesenteric extrahepatic portosystemic shunt in patients with cavernous transformation of the portal vein complicated by superior mesenteric vein occlusion.</p> Materials and Methods <p>Twenty-one consecutive patients underwent transmesenteric extrahepatic portosystemic shunt, including 13 men (62%), with a median age of 50&#xa0;years (interquartile range, 43.5–56.5&#xa0;years). As a hybrid procedure, the superior mesenteric vein was accessed through a mini-laparotomy and recanalized when feasible. A direct extrahepatic portosystemic shunt was then created by puncturing the inferior vena cava, and mechanical thrombectomy with catheter-directed thrombolysis was performed for recent thrombus when indicated. Technical success, clinical outcomes, complications, and stent patency were systematically evaluated during follow up.</p> Results <p>The technical success rate of transmesenteric extrahepatic portosystemic shunt was 95.2% (20/21). The balloon assisted puncture technique achieved a 100% success rate (20/20), with successful puncture on the first attempt in 85% of patients (17/20). The mean superior mesenteric vein pressure significantly decreased from 29.9 ± 5.92&#xa0;mmHg to 17.5 ± 2.50&#xa0;mmHg (<i>p</i> = 0.003). No intra-abdominal hemorrhage occurred. The median follow-up duration was 18&#xa0;months (interquartile range, 11–30&#xa0;months). At 48&#xa0;months, the cumulative stent patency rate was 75%, and the overall survival rate was 89.6%.</p> Conclusion <p>Transmesenteric extrahepatic portosystemic shunt may represent a complementary extrahepatic shunting option for carefully selected patients with cavernous transformation of the portal vein and extensive mesenteric venous occlusion, particularly when conventional intrahepatic shunt techniques are technically unfeasible or associated with high procedural risk.</p> Graphical Abstract

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Transmesenteric Extrahepatic Portosystemic Shunt for Cavernous Transformation of Portal Vein with Superior Mesenteric Vein Occlusion

  • 期刊论文

  • 发表日期：

    2026年6月17日

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  • Wenhao Li,
  • Heng Zhang,
  • Kerun Mu,
  • Weixiao Li,
  • Mingzhe Cui,
  • Shuiting Zhai,
  • Kun Tian,
  • Tao Qin

摘要

Purpose

To evaluate the feasibility, safety, and clinical efficacy of transmesenteric extrahepatic portosystemic shunt in patients with cavernous transformation of the portal vein complicated by superior mesenteric vein occlusion.

Materials and Methods

Twenty-one consecutive patients underwent transmesenteric extrahepatic portosystemic shunt, including 13 men (62%), with a median age of 50 years (interquartile range, 43.5–56.5 years). As a hybrid procedure, the superior mesenteric vein was accessed through a mini-laparotomy and recanalized when feasible. A direct extrahepatic portosystemic shunt was then created by puncturing the inferior vena cava, and mechanical thrombectomy with catheter-directed thrombolysis was performed for recent thrombus when indicated. Technical success, clinical outcomes, complications, and stent patency were systematically evaluated during follow up.

Results

The technical success rate of transmesenteric extrahepatic portosystemic shunt was 95.2% (20/21). The balloon assisted puncture technique achieved a 100% success rate (20/20), with successful puncture on the first attempt in 85% of patients (17/20). The mean superior mesenteric vein pressure significantly decreased from 29.9 ± 5.92 mmHg to 17.5 ± 2.50 mmHg (p = 0.003). No intra-abdominal hemorrhage occurred. The median follow-up duration was 18 months (interquartile range, 11–30 months). At 48 months, the cumulative stent patency rate was 75%, and the overall survival rate was 89.6%.

Conclusion

Transmesenteric extrahepatic portosystemic shunt may represent a complementary extrahepatic shunting option for carefully selected patients with cavernous transformation of the portal vein and extensive mesenteric venous occlusion, particularly when conventional intrahepatic shunt techniques are technically unfeasible or associated with high procedural risk.

Graphical Abstract