05/19/2026
NEW IN JVIR: Transvenous Extrahepatic Portosystemic Shunts (TEPS): Intravascular Ultrasound-Guided Creation of Portocaval, Mesocaval, and Splenorenal Shunts
π Clinical Question:
To evaluate the feasibility and long-term safety and effectiveness of intravascular ultrasound (IVUS)-guided transvenous extrahepatic portosystemic shunt (TEPS) creation for patients unsuitable for transjugular intrahepatic portosystemic shunt (TIPS) creation.
π‘ Key Insight:
Intravascular ultrasound (IVUS)-guided creation of portocaval, mesocaval, and splenorenal transvenous extrahepatic portosystemic shunts was technically successful in 100% of 23 patients, with 100% 1-year primary patency and 100% 3-year primary assisted patency. One Grade 3 periprocedural adverse event of acute kidney injury occurred. No Grade >2 major hemorrhage or hollow viscus organ injury. Delayed hepatopulmonary and portopulmonary syndromes, attributed to decreased hepatic clearance of splanchnic vasoactive substances, occurred in 2 patients.
π Why it matters:
Transvenous extrahepatic portosystemic shunts may offer a last resort for portomesenteric decompression in patients with obliterated portomesenteric vasculature or an obstructed intrahepatic path. The IVUS-guided transvenous technique is entirely endovascular and provides real-time visualization of retroperitoneal vessels and organs while avoiding open surgery and risk of traversing hollow viscus organs.
β‘οΈ Full Article:
https://brnw.ch/21x2CIF