Effect of Portosystemic Shunt Obliteration on Portal Vein Size and the Incidence of Subsequent Portal Vein Thrombosis.

Monday, March 31, 2025

3:45 PM – 3:54 PM CT

Location: Music City Center, 204

Presenting Author(s)

Charles R. Diard, MD (he/him/his)

Radiology Resident
University of South Alabama, United States

Author/Co-author(s)

ZH

Zeiad Hussain, MD

Attending physician, Interventional Radiology
University of South Alabama, United States
BW

Brian Wood, DO

Interventional Radiology Attending
University of South Alabama, United States
OA

Osama Abdul-Rahim, MD

Interventional Radiologist
Stride Healthcare, United States
Lucas F. Sheridan, DO (he/him/his)

Radiology Resident
University of South Alabama, United States
AS

Anas Souid, MD

Radiology Resident
University of South Alabama, United States
HR

Hunaid Rana, MD

Interventional Radiology Fellow
University of Texas Health Science Center, United States

Purpose: To evaluate changes in portal vein size and the incidence of portal vein thrombus formation after portosystemic shunt obliteration.

Materials and Methods: We conducted a retrospective review of institutional data collected from May 2017 to July 2023 including patients who underwent Portosystemic Shunt(PSS) obliteration. Portal vein(PV) size was measured on cross sectional imaging performed before and after PSS embolization by 2 independent interventional radiologists. Discrepancies between measured values were reviewed for an agreed upon value. Post procedural portal vein size and incidence of portal vein thrombosis were followed serially by cross sectional imaging, with average follow up 17 months post procedure.

Results: Fifty-two patients (23 male, average age 57), all with advanced cirrhosis, who underwent PSS embolization for hepatic encephalopathy, were reviewed. Four were lost to follow-up. There was 1 mortality secondary to bleeding. Portal vein size averaged 1.36 cm before and 1.47 cm after PSS embolization (p < 0.05) with a mean increase in PV size overall of 0.13 cm (95% CI [0.05, 0.20]. In a subgroup of patients with whose baseline PV less than 1 cm in size (7 patients), there was an average increase of 0.42 cm (95% CI [0.09,0.75]. Portal vein thrombus formation occurred in 7 patients, of which 5 were partial non-occlusive thrombus.

Conclusion: This study demonstrates a significant increase in PV size after PSS obliteration. This increase in size was more notable in patients with baseline PV size less than 1 cm. PSS obliteration affects many aspects relevant to hepatic transplant. Increased PV size after obliteration may help ensuring adequate portal flow, which is vital for transplant success{1,2,3}. Pre-transplant PSS obliteration also decreases the risk of previously identified portal flow steal secondary to PSS and may help alleviating the risk of cavernous transformations and PV thrombosis, which are known challenges in liver transplant{2,3,4}. A larger prospective study is needed to confirm these findings.