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Semin intervent Radiol 2018; 35(03): 160-164
DOI: 10.1055/s-0038-1660794
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Portal Hypertension in the Pediatric Population: A Primer for the Interventional Radiologist

Victoria Young
1   Department of Diagnostic Radiology, Northwestern Memorial Hospital, Chicago, Illinois
2   Department of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
,
Shankar Rajeswaran
2   Department of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
3   Department of Pediatric Vascular and Interventional Radiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
› Author Affiliations
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Publication History

Publication Date:
06 August 2018 (online)

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Abstract

Interventional radiology's role in the management of portal hypertension in the pediatric population differs from the management of adult portal hypertension. In the pediatric population, portal hypertension is frequently secondary to thrombosis and cavernous transformation of the extrahepatic portion of the portal vein. Transjugular intrahepatic portosystemic shunt can be utilized to manage portal hypertension in children with intrinsic liver disease that results in cirrhosis and portal hypertension, and is often used as a bridge to transplant. While technically feasible in extrahepatic portal vein occlusion, the sequelae of portosystemic shunting are less desirable in a child. The Meso-Rex bypass procedure, which represents the mainstay of management for pediatric portal hypertension, provides surgical relief of extrahepatic portal vein obstruction and restores mesenteric venous blood flow to the liver. This article aims to review management of portal hypertension in children as it pertains to the interventional radiologist, including preoperative assessment, postoperative evaluation, and the management of complications of the Meso-Rex bypass.

Keywords

Meso-Rex bypass - Rex shunt - cavernous transformation - portal hypertension - extrahepatic portal vein obstruction
 

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