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SIR 2026

Educational Exhibit

Transplant Interventions

Session: Educational Exhibit Presentations - Portal hypertension/Transplant/GI

783 - Portal Vein Thrombosis in Liver Transplant Candidates: Interventional Strategies and Teaching for the Modern IR

Monday, April 13, 2026
5:03 PM - 5:09 PM ET
Learning Objectives:


  • Review the incidence, risk factors, and clinical implications of portal vein thrombosis (PVT) in cirrhotic patients being evaluated for liver transplantation.



  • Understand the technical aspects and evolving role of portal vein recanalization–TIPS (PVR-TIPS) in restoring physiologic portal inflow prior to transplant.



  • Identify complication management strategies and multidisciplinary considerations essential for optimizing outcomes in this complex patient cohort.




Background: Portal vein thrombosis occurs in up to 26% of decompensated cirrhotic patients awaiting transplantation and historically limited surgical candidacy. Advances in interventional radiology have shifted management, with PVR-TIPS emerging as a cornerstone technique to recanalize thrombosed portal veins, facilitate physiologic anastomoses, and reduce post-transplant morbidity. Understanding classification systems, appropriate patient selection, and technical strategies are essential for interventional radiologists caring for this high-risk population.

Clinical Findings/Procedure Details:


  • Review common classification schemes of PVT (Yerdel, Jamieson, Charco) and their impact on transplant decision-making.



  • Illustrate step-wise procedural details of PVR-TIPS, including role of transjugular, transplenic, and transmesenteric approaches, supported by imaging examples.



  • Discuss technical pearls such as wire/catheter selection, “gun-sight” techniques for recanalization, and strategies to maximize portal patency while preserving surgical options.



  • Present evidence on outcomes: success rates of 95–98% with sustained patency, and high rates of physiologic anastomosis in transplant recipients




Conclusion and/or Teaching Points: PVT remains a major barrier in liver transplantation, but advances in interventional techniques — particularly PVR-TIPS — allow restoration of portal inflow and expand transplant candidacy. Mastery of classification systems, procedural strategies, and multidisciplinary coordination equips interventional radiologists to optimize peri-transplant outcomes. Ongoing education, research, and dissemination of technical pearls are vital as this field continues to evolve.