51. Portosystemic shunt as a bridge to liver transplantation in infants: A comparison of two techniques
- Author
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Michael L. Kueht, Dor Yoeli, Abbas Rana, Christine A. O'Mahony, N. Thao N. Galvan, Ellen D. Witte, John A. Goss, Kayla R. Kumm, Tamir Miloh, Daniel Ashton, and Ronald T. Cotton
- Subjects
Transplantation ,medicine.medical_specialty ,Percutaneous ,business.industry ,Decompression ,medicine.medical_treatment ,Liver transplantation ,medicine.disease ,030218 nuclear medicine & medical imaging ,Surgery ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Bridge (graph theory) ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,medicine ,In patient ,Portosystemic shunt ,business ,Transjugular intrahepatic portosystemic shunt - Abstract
Portosystemic shunts can serve as a bridge to liver transplantation in patients with end-stage liver disease by providing portal decompression to treat life-threatening variceal bleeding and prevent recurrent episodes until an organ becomes available. The conventional TIPS procedure, however, is technically challenging to perform in infants due to the small size of their intrahepatic vasculature. We report two cases of emergent creation of portosystemic shunts as a bridge to liver transplantation in infants with life-threatening variceal bleeding using a conventional TIPS technique in the first case and a percutaneous DIPS technique in the other. Both procedures were successful at reducing the portosystemic pressure gradient and preventing further variceal bleeds until a liver transplant could be performed. The novel percutaneous DIPS procedure is a valuable alternative to the conventional TIPS in infants, as it is better suited for small or challenging intrahepatic vascular anatomy.
- Published
- 2017