title: Portal venous remodeling after endovascular reduction of pediatric autogenous portosystemic shunts.
abstract: Patients with autogenous native vessel portosystemic shunts, whether surgical or congenital, may experience complications of excess shunt flow, including hepatopulmonary syndrome (HPS), hepatic encephalopathy (HE), and hepatic insufficiency. The authors explored endovascular reduction or occlusion of autogenous portosystemic shunts using methods commonly employed in transjugular intrahepatic portosystemic shunt (TIPS) reduction in four pediatric patients. Before treatment, the patients had hypoplastic, atrophic, or thrombosed portal veins. Following intervention, symptoms of overshunting resolved or improved in all patients without major complications. The innate plasticity of the pediatric portal venous system allowed for hypertrophy or development and maturation of cavernous transformations to accommodate increased hepatopetal blood flow and pressure.
authors.affiliation: Division of Interventional Radiology, H-3646, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305-5642, USA.
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Stewart
authors.forename: William T
authors.initials: WT
authors.lastname: Kuo
authors.forename: David M
authors.initials: DM
authors.lastname: Hovsepian
authors.forename: Lawrence V
authors.initials: LV
authors.lastname: Hofmann
authors.forename: Clark A
authors.initials: CA
authors.lastname: Bonham
authors.forename: Daniel Y
authors.initials: DY
authors.lastname: Sze
mesh_terms: D000015:Abnormalities, Multiple; D000293:Adolescent; D001807:Blood Vessel Prosthesis; D002648:Child; D006801:Humans; D007223:Infant; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D011169:Portal Vein / Q000002:abnormalities* / Q000601:surgery*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*; D015641:Radiography, Interventional; D015607:Stents; D014057:Tomography, X-Ray Computed; D054079:Vascular Malformations / Q000601:surgery*; D020246:Venous Thrombosis / Q000601:surgery*