Meso-cavo-jugular shunt for complicated portal hypertension: a case report with 8 years of follow-up.
BACKGROUND
The treatment of portal hypertension caused by an occlusive lesion in the retrohepatic inferior vena cava and terminal portal venules is complicated because both portal and system venous flow are compromised.


METHODS
A 47-year-old woman presented with this issue, and we reasoned that the only way to achieve successful management was to create a meso-cavo-jugular shunt. This patient was referred to us after undergoing a splenectomy for hypersplenism, which made her ascites intractable. She had a retrohepatic vena caval stenosis and noncirrhotic portal hypertension. Percutaneous transluminal angioplasty of the inferior vena cava stenosis failed. She underwent substernal placement of a 14-mm ringed GoreTex graft (WL Gore and Associates, Flagstaff, AZ) with end-to-side connections to the superior mesenteric vein, internal jugular vein, and vena cava.


RESULTS
Her ascites resolved, and at follow-up 8 years later her graft was patent.


CONCLUSIONS
The meso-cavo-jugular shunt can simultaneously decompress both portal and systemic venous systems and is worth considering in the rare circumstance of suprahepatic vena caval obstruction coupled with occlusion of the portal venules.
Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Zhi-Wei
ZW
Hu
Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China. Electronic address: zhonggaowang@126.com.
Zhong-Gao
ZG
Wang
Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Yong-Quan
YQ
Gu
Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Bing
B
Chen
Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Guang-Chang
GC
Zhu
D001201:Ascites / Q000209:etiology; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008642:Mesenteric Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D017082:Portal Pressure; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*