SIR 2024
Portal Hypertension
Faris Gulamali, BA
Medical Student
Icahn School of Medicine at Mount Sinai Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Daryl Goldman, MD
Resident
Icahn School of Medicine at Mount Sinai
Disclosure information not submitted.
F Scott Nowakowski, MD
Professor of Radiology and Surgery
Mount Sinai Medical System
Disclosure information not submitted.
Robert A. Lookstein, MD
Executive Vice Chair; Diagnostic, Molecular, and Interventional Radiology
Mount Sinai Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Rahul S. Patel, MD
Assistant Professor, Diagnostic, Molecular and Interventional Radiology
Mount Sinai Medical Center\n
Financial relationships: Full list of relationships is listed on the CME information page.
Four subjects were identified - 75% female, mean age 51.3 (range: 30-62). Three patients had a diagnosed underlying coagulopathy, three had clinically significant variceal hemorrhage, and two had an occluded or failed intrahepatic shunt. Mean followup time was 54 months (4 months to 10 years).
Results: There was a 100% technical success rate. There were no immediate procedure related complications, including abdominal hemorrhage, infection, heart failure, and uncorrectable hepatic encephalopathy. There were no episodes of variceal hemorrhage across the length of follow up. Shunts demonstrate primary, primary-assisted, and secondary patency rates of 50%, 100%, and 100% respectively. Two shunts underwent revision to maintain patency and one was revised due to concern for stent migration.
Conclusion: Endovascular mesocaval shunting is technically feasible and relatively safe in patients with mesenteric varices in the setting of chronic portomesenteric thrombosis. Continued imaging surveillance is crucial for prompting intervention prior to the recurrence of symptoms.