title: Imaging and radiological interventions in extra-hepatic portal vein obstruction.
abstract: Extrahepatic portal vein obstruction (EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension (PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt (PSS) and revision of PSS.
authors.affiliation: Sudheer S Pargewar, S Rajesh, Amar Mukund, Division of Interventional Radiology, Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi 110070, India.
authors.forename: Sudheer S
authors.initials: SS
authors.lastname: Pargewar
authors.affiliation: Sudheer S Pargewar, S Rajesh, Amar Mukund, Division of Interventional Radiology, Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi 110070, India.
authors.forename: Saloni N
authors.initials: SN
authors.lastname: Desai
authors.affiliation: Sudheer S Pargewar, S Rajesh, Amar Mukund, Division of Interventional Radiology, Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi 110070, India.
authors.forename: S
authors.initials: S
authors.lastname: Rajesh
authors.affiliation: Sudheer S Pargewar, S Rajesh, Amar Mukund, Division of Interventional Radiology, Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi 110070, India.
authors.forename: Vaibhav P
authors.initials: VP
authors.lastname: Singh
authors.affiliation: Sudheer S Pargewar, S Rajesh, Amar Mukund, Division of Interventional Radiology, Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi 110070, India.
authors.forename: Ankur
authors.initials: A
authors.lastname: Arora
authors.affiliation: Sudheer S Pargewar, S Rajesh, Amar Mukund, Division of Interventional Radiology, Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi 110070, India.
authors.forename: Amar
authors.initials: A
authors.lastname: Mukund
keywords: Extrahepatic portal venous obstruction; Portal cavernoma; Portal hypertension; Splenic embolization; Transjugular intrahepatic portosystemic shunt