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Portal vein thrombosis (PVT) is a heterogeneous condition with multiple possible etiologies and to varying degrees has historically limited candidacy for liver transplant (LT) in the cirrhotic patient population due to resultant difficulties in constructing a robust portal vein anastomosis. While intraoperative approaches to managing PVT are well-described, methods which approximate normal portal physiology are not always feasible depending on the extent of PVT, and other nonphysiologic techniques are linked with substantial morbidity and poor long-term outcomes. Portal vein recanalization–transjugular intrahepatic portosystemic shunt (PVR-TIPS) creation is an efficacious method of restoring physiologic portal flow in cirrhotic patients prior to LT allowing for end-to-end PV anastomosis, and is the product of decades-long institutional expertise in TIPS/LT and the support of a multidisciplinary liver tumor board. To follow is a review of the pertinent pathophysiology of PVT in cirrhosis, the rationale leading to the development and subsequent evolution of the PVR-TIPS procedure, technical lessons learned, and a summary of outcomes to date. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a major cause of cancer-related morbidity and mortality around the world. Frequently, concurrent liver dysfunction and variations in tumor burden make it difficult to design effective and standardized treatment pathways. Contemporary treatment guidelines designed for an era of personalized medicine should consider these features in a more clinically meaningful way to improve outcomes for patients across the HCC spectrum. Given the heterogeneity of HCC, we propose a detailed clinical algorithm for selecting optimal treatment using an evidence-based and practical approach, incorporating liver function, tumor burden, the extent of disease, and ultimate treatment intent, with the goal of individualizing clinical decision making. [ABSTRACT FROM AUTHOR]

Background and Aims: Transcatheter arterial embolization (TAE) has been repeatedly shown as an effective method of controlling acute hemorrhage. Arterial access for TAE in the emergent setting is typically trans-femoral, though other routes are routinely used. The presence of abnormal vasculature such as an aortic dissection increases the difficulty of TAE.Case Report: This report details a case of acute hemorrhage likely from a ruptured hepatocellular carcinoma in which the celiac artery originated from the false lumen of a type B aortic dissection.Conclusion: The false lumen was catheterized via left radial artery access and the bleeding hepatic arterial branch was successfully embolized. [ABSTRACT FROM AUTHOR]

Congenital intrahepatic portosystemic venous shunts are rare vascular malformations which are incidentally discovered on imaging or once hepatic encephalopathy becomes clinically apparent. Surgical ligation and endovascular embolization are potential treatments. [ABSTRACT FROM AUTHOR]

Introduction: Right portal vein embolization (PVE) has become a crucially important option in the minimally-invasive treatment of hepatocellular carcinoma or secondary liver malignancy before partial hepatectomy or trisegmentectomy to reduce perioperative morbidity. The main goal of PVE is to increase the volume of the future liver remnant (FLR), which can provide complete liver metabolic functionality without risk of developing posthepatectomy liver failure, also known as "small for size syndrome." PVE accomplishes this via the redirection of portal venous flow toward the left portal vein circulation resulting in an increased left hepatic lobe volume.Case Report: We present a patient with a noncirrhotic liver and a previously unknown portal venous to systemic venous shunt that became apparent after a right PVE was completed. Left untreated, this shunt would have undoubtedly jeopardized the FLR volume.Conclusion: The presence of previously undetected portosystemic shunting is a potential cause for otherwise assumed idiopathic PVE failure, and the goal of this article is to underscore the importance of evaluating for these shunts before PVE. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors have no conflicts to report.