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Transvenous Extrahepatic Portosystemic Shunts (TEPS): Intravascular Ultrasound-Guided Creation of Portocaval, Mesocaval, and Splenorenal Shunts.

Transvenous Extrahepatic Portosystemic Shunts (TEPS): Intravascular Ultrasound-Guided Creation of Portocaval, Mesocaval, and Splenorenal Shunts. Journal of vascular and interventional radiology : JVIR Gupta, A. N., Louie, J. D., Sze, D. Y. 2026: 108596

Abstract

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.A single-center, retrospective study was performed in 23 patients (19 adult, 4 pediatric; median 55.7 years, range 8-75 years; male N=13, 57%) who underwent 24 TEPS creations for variceal bleeding (N=20, 83%), refractory ascites (N=3, 13%), or pre-operative portal decompression (N=1, 4%). Rationale for extrahepatic shunt included chronic portal vein occlusion (N=17, 71%), chronic SMV occlusion (N=2, 8%), obstructed intrahepatic path (N=3, 13%), complex Budd-Chiari (N=1, 4%), and intentional portosplenic blood flow separation (N=1, 4%). Baseline characteristics included active cancer (N=6, 27%), cirrhosis (N=9, 41%), and liver transplant (N=4, 22%). Primary outcomes were technical success and periprocedural adverse events. Secondary outcomes were patency, delayed adverse events, and overall survival (OS).Technical success was 100% for portocaval (N=16, 67%), superior mesocaval (N=5, 21%), inferior mesocaval (N=1, 4%), and splenorenal shunts (N=2, 8%). Periprocedural adverse events included 9 grade 1-2 events (38%) and one grade 3 acute kidney injury (4%). One-year primary patency was 100% and 3-year primary assisted patency was 100%. Recurrent variceal bleeding developed in 4 patients (17%); refractory ascites did not recur. Eight patients (36%) developed hepatic encephalopathy, managed medically. Hepatopulmonary and portopulmonary syndromes occurred in 1 patient each (4%, 4%). Median OS was 38.4 months, shorter in patients with active cancer (10.4 vs 104.8 months, p=0.026).IVUS-guided TEPS creation is feasible, effective, and durable in patients with complications of portal hypertension not suitable for conventional recanalization or TIPS creation.

View details for DOI 10.1016/j.jvir.2026.108596

View details for PubMedID 41713725