title: Assessment of surgical portosystemic shunts and associated complications: The diagnostic and therapeutic role of radiologists.
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.
authors.affiliation: Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020-PO Box: 11-0236, Beirut, Lebanon. Electronic address: btaslakian@gmail.com.
authors.forename: Bedros
authors.initials: B
authors.lastname: Taslakian
authors.affiliation: Department of General Surgery, American University of Beirut Medical Center, Riad El-Solh 1107 2020-PO Box: 11-0236, Beirut, Lebanon. Electronic address: wf07@aub.edu.lb.
authors.forename: Walid
authors.initials: W
authors.lastname: Faraj
authors.affiliation: Department of General Surgery, American University of Beirut Medical Center, Riad El-Solh 1107 2020-PO Box: 11-0236, Beirut, Lebanon. Electronic address: mk12@aub.edu.lb.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Khalife
authors.affiliation: Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020-PO Box: 11-0236, Beirut, Lebanon. Electronic address: mk00@aub.edu.lb.
authors.forename: Aghiad
authors.initials: A
authors.lastname: Al-Kutoubi
authors.affiliation: Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020-PO Box: 11-0236, Beirut, Lebanon. Electronic address: fe19@aub.edu.lb.
authors.forename: Fadi
authors.initials: F
authors.lastname: El-Merhi
authors.affiliation: Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020-PO Box: 11-0236, Beirut, Lebanon. Electronic address: cs39@aub.edu.lb.
authors.forename: Charbel
authors.initials: C
authors.lastname: Saade
authors.affiliation: Department of General Surgery, American University of Beirut Medical Center, Riad El-Solh 1107 2020-PO Box: 11-0236, Beirut, Lebanon. Electronic address: ah05@aub.edu.lb.
authors.forename: Ali
authors.initials: A
authors.lastname: Hallal
authors.affiliation: Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020-PO Box: 11-0236, Beirut, Lebanon. Electronic address: ah24@aub.edu.lb.
authors.forename: Ali
authors.initials: A
authors.lastname: Haydar
mesh_terms: D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology; D011170:Portasystemic Shunt, Surgical; D011183:Postoperative Complications / Q000175:diagnosis*; D013927:Thrombosis / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
keywords: Budd–Chiari syndrome; Imaging; Interventional radiology; Portal hypertension; Portosystemic shunt; Surgical portosystemic shunt