Interventional Radiology Management of Pediatric Portal Venous Pathologies.

Area of Science:

• Pediatric Gastroenterology
• Interventional Radiology
• Vascular Surgery

Background:

• Portal venous pathology is a primary cause of prehepatic portal hypertension in children.
• Portal vein thrombosis (PVT) is the most common etiology, affecting both native livers and post-transplant cases.
• Surgical shunts (Meso-Rex, Warren) are traditional first-line treatments.

Purpose of the Study:

• To review current interventional radiology (IR) techniques for managing pediatric portal venous disorders.
• To highlight the role of IR as a primary and adjunctive treatment strategy.
• To discuss technical aspects and outcomes of IR procedures.

Main Methods:

• Portal vein recanalization (PVR) for restoring blood flow.
• Salvage procedures for thrombosed Meso-Rex and Warren shunts.
• Transjugular intrahepatic portosystemic shunt (TIPS) placement.
• Emphasis on pediatric-specific access strategies (translienal puncture, CBCT guidance, wire targeting, stent selection).

Main Results:

• IR techniques provide effective primary and adjunctive management options.
• Successful salvage of thrombosed surgical shunts is achievable.
• PVR and TIPS offer viable alternatives or adjuncts to surgical management.
• Outcome data, where available, support the efficacy of these IR interventions.

Conclusions:

• Interventional radiology plays an increasingly central role in managing pediatric portal venous pathology.
• Advanced IR techniques offer effective solutions for complex cases, including shunt thrombosis and portal hypertension.
• Pediatric-specific approaches enhance the safety and success of IR interventions in this population.