Transmesenteric Extrahepatic Portosystemic Shunt for Portal Vein Cavernous Transformation with Symptomatic Portal...

To assess transmesenteric extrahepatic portosystemic shunt (TmEPS) insertion in treatment of portal hypertension in patients with cavernous transformation of the portal vein (CTPV).

In this single-center retrospective study, 70 patients with CTPV underwent TmEPS between January 2021 and December 2024. The technical success, stent dysfunction, procedure-related adverse events, overall survival, and incidence of hepatic encephalopathy (HE) were analyzed. Follow-up continued until the most recent clinical assessment or death.

Seventy patients underwent TmEPS consecutively (42 men, 60%; mean age, 55.6 years [SD ± 11.6]). The procedure achieved a 100% technical success rate without procedure-related mortality. Mean portal pressure gradient decreased significantly from 21.9 mm Hg (SD ± 3.1) to 10.6 mm Hg (SD ± 3.2) (P < .001). Five patients developed perioperative adverse events, all of which were successfully managed. During a median follow-up of 11.0 months (range, 5.0-27.5 months), stent dysfunction developed in 4 patients, with 1 case of recurrent bleeding resolved by reintervention. Cumulative stent patency rates were 95%, 92%, and 86% at 12, 24, and 36 months, respectively. The incidence rates of HE were 14% at 12 months and 23% at both 24 and 36 months. The corresponding cumulative survival rates were 85%, 79%, and 74%.

TmEPS may serve as a complementary option for managing portal hypertension in selected patients with CTPV.