Multistage closure of a congenital extrahepatic portosystemic shunt

Abstract Background Congenital extrahepatic portosystemic shunts (CEPS) are rare shunts connecting the extrahepatic portal system with the inferior vena cava. Shunt dimensions and the risk of portal hypertension determines the closure strategy. Endovascular treatment is indicated for single stage oc...

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Autores principales:	João Facas, Manuel Cruz, João Filipe Costa, Alfredo Agostinho, Paulo Donato
Formato:	article
Lenguaje:	EN
Publicado:	SpringerOpen 2021
Materias:	Congenital extrahepatic portosystemic shunt Abernethy Atrial septal defect occluder Transjugular intrahepatic portosystemic shunt Balloon occlusion venography Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/249d55cf9be344698dc5283a1a5d075f
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spelling	oai:doaj.org-article:249d55cf9be344698dc5283a1a5d075f2021-11-21T12:42:17ZMultistage closure of a congenital extrahepatic portosystemic shunt10.1186/s42155-021-00267-x2520-8934https://doaj.org/article/249d55cf9be344698dc5283a1a5d075f2021-11-01T00:00:00Zhttps://doi.org/10.1186/s42155-021-00267-xhttps://doaj.org/toc/2520-8934Abstract Background Congenital extrahepatic portosystemic shunts (CEPS) are rare shunts connecting the extrahepatic portal system with the inferior vena cava. Shunt dimensions and the risk of portal hypertension determines the closure strategy. Endovascular treatment is indicated for single stage occlusion of longer length shunts, whereas the remaining shunt types are preferentially surgically occluded. Herein we describe the technical details of a novel endovascular treatment for short length CEPS. Case presentation A 15-years-old male with a short length CEPS complicated with multinodular liver disease was submitted to a multistage closure, as indicated by the high portal pressure values during shunt balloon occlusion venography. Initially a transjugular intrahepatic portosystemic shunt (TIPS) was created and the CEPS occluded with an atrial septal defect occluder. In a second procedure the TIPS was embolized with a flow reductor stent and an amplatzer vascular plug II. At a 1 year follow up the liver nodules size reduced, the patient remains asymptomatic, and the shunt adequately closed. Conclusion This paper outlines the potential use of a TIPS and an atrial septal defect occluder combination in complex CEPS, supporting its usage as an alternative to the standard surgical treatment. Level of Evidence: Level 4, Case report.João FacasManuel CruzJoão Filipe CostaAlfredo AgostinhoPaulo DonatoSpringerOpenarticleCongenital extrahepatic portosystemic shuntAbernethyAtrial septal defect occluderTransjugular intrahepatic portosystemic shuntBalloon occlusion venographyDiseases of the circulatory (Cardiovascular) systemRC666-701ENCVIR Endovascular, Vol 4, Iss 1, Pp 1-4 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Congenital extrahepatic portosystemic shunt Abernethy Atrial septal defect occluder Transjugular intrahepatic portosystemic shunt Balloon occlusion venography Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Congenital extrahepatic portosystemic shunt Abernethy Atrial septal defect occluder Transjugular intrahepatic portosystemic shunt Balloon occlusion venography Diseases of the circulatory (Cardiovascular) system RC666-701 João Facas Manuel Cruz João Filipe Costa Alfredo Agostinho Paulo Donato Multistage closure of a congenital extrahepatic portosystemic shunt
description	Abstract Background Congenital extrahepatic portosystemic shunts (CEPS) are rare shunts connecting the extrahepatic portal system with the inferior vena cava. Shunt dimensions and the risk of portal hypertension determines the closure strategy. Endovascular treatment is indicated for single stage occlusion of longer length shunts, whereas the remaining shunt types are preferentially surgically occluded. Herein we describe the technical details of a novel endovascular treatment for short length CEPS. Case presentation A 15-years-old male with a short length CEPS complicated with multinodular liver disease was submitted to a multistage closure, as indicated by the high portal pressure values during shunt balloon occlusion venography. Initially a transjugular intrahepatic portosystemic shunt (TIPS) was created and the CEPS occluded with an atrial septal defect occluder. In a second procedure the TIPS was embolized with a flow reductor stent and an amplatzer vascular plug II. At a 1 year follow up the liver nodules size reduced, the patient remains asymptomatic, and the shunt adequately closed. Conclusion This paper outlines the potential use of a TIPS and an atrial septal defect occluder combination in complex CEPS, supporting its usage as an alternative to the standard surgical treatment. Level of Evidence: Level 4, Case report.
format	article
author	João Facas Manuel Cruz João Filipe Costa Alfredo Agostinho Paulo Donato
author_facet	João Facas Manuel Cruz João Filipe Costa Alfredo Agostinho Paulo Donato
author_sort	João Facas
title	Multistage closure of a congenital extrahepatic portosystemic shunt
title_short	Multistage closure of a congenital extrahepatic portosystemic shunt
title_full	Multistage closure of a congenital extrahepatic portosystemic shunt
title_fullStr	Multistage closure of a congenital extrahepatic portosystemic shunt
title_full_unstemmed	Multistage closure of a congenital extrahepatic portosystemic shunt
title_sort	multistage closure of a congenital extrahepatic portosystemic shunt
publisher	SpringerOpen
publishDate	2021
url	https://doaj.org/article/249d55cf9be344698dc5283a1a5d075f
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Multistage closure of a congenital extrahepatic portosystemic shunt

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