Endovascular Alternatives to Transhepatic Shunt Creation

Ishan Sinha, Daryl T. Goldman, Rahul S. Patel, Francis S. Nowakowski

Research output: Contribution to journalReview articlepeer-review


Portomesenteric decompression is often necessary to treat patients with refractory symptoms of portal hypertension. When transjugular or direct intrahepatic portosystemic shunt creation is not feasible or is inadequate, surgical portosystemic shunt creation is considered, which carries significant morbidity and mortality in these high-risk patients. Surgery is further complicated in patients with portomesenteric thrombosis who require concurrent thrombectomy and long-term anticoagulation. In this article, we outline the technique for performing advanced endovascular alternatives to intrahepatic portosystemic shunt creation including mesocaval and splenorenal shunting. We will also discuss some of the clinical considerations for treating these patients with symptomatic portal hypertension and portomesenteric thrombosis.

Original languageEnglish
Pages (from-to)73-78
Number of pages6
JournalSeminars in Interventional Radiology
Issue number1
StatePublished - 4 May 2023


  • interventional radiology
  • mesocaval shunt
  • portal vein thrombosis
  • splenorenal shunt
  • transjugular intrahepatic portosystemic shunt


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