Trombosis venosa portal extrahepática, manejo quirúrgico con derivación meso-Rex. Serie de 3 casos / Extrahepatic portal vein thrombosis, surgical management with meso-Rex shunt. Series of 3 cases

La vena porta es un conducto que drena el flujo esplácnico al hígado y se puede ocluir por diferentes patologías, variando su presentación clínica de acuerdo con la causa de la obstrucción. Es muy importante diferenciar la trombosis portal asociada o no a la cirrosis, ya que su tratamiento y pronóstico es diferente. La trombosis venosa portal extrahepática es una condición netamente de origen vascular, y es la principal causa de trombosis portal en niños y adultos. Presentamos tres casos tratados con derivación meso-Rex, con seguimiento a 6 meses

The portal vein is a conduit that drains splanchnic flow to the liver, it can be occluded by different pathologies and its clinical presentation varies according to the cause of the obstruction. It is very important to differentiate portal thrombosis associated or not with cirrhosis, since its treatment and prognosis is different. Extrahepatic portal vein thrombosis (PEVT) is a condition of purely vascular origin, being the main cause of portal thrombosis in children and adults. We present three cases with meso-Rex shunt, with a 6-month follow-up

Development of Hepatocellular Carcinoma in Patients with Glycogen Storage Disease: a Single Center Retrospective Study

Mesocaval Shunt Creation for Jejunal Variceal Bleeding with Chronic Portal Vein Thrombosis

The creation of transjugular intrahepatic portosystemic shunt (TIPS) is a widely performed technique to relieve portal hypertension, and to manage recurrent variceal bleeding and refractory ascites in patients where medical and/or endoscopic treatments have failed. However, portosystemic shunt creation can be challenging in the presence of chronic portal vein occlusion. In this case report, we describe a minimally invasive endovascular mesocaval shunt creation with transsplenic approach for the management of recurrent variceal bleeding in a portal hypertension patient with intra- and extrahepatic portal vein occlusion.

Escleroterapia endoscópica asistida mediante balón oclusivo como tratamiento de varices gástricas cardiofúndicas de alto riesgo: reporte de dos casos y revisión de la literatura / Fundal variceal bleeding treated with balloon occluded endoscopic inyection sclerotherapy: report of two cases

Management of gastrointestinal bleeding caused by fundal varices is particularly difficult to manage. The options are: transjugular intrahepatic portosystemic shunt (TIPS), endoscopic injection of cyanoacrylate or balloon-occluded retrograde transvenous obliteration (BRTO). We report a 63 year-old male with a cirrhosis caused by hepatitis C and a 66 year-old female with a cirrhosis caused by a non-alcoholic steatohepatitis. Both patients had a gastrointestinal bleeding caused by fundal varices and were treated with sclerotherapy with cyanoacrylate assisted with BRTO. Flow was interrupted in the gastro-renal shunt by a femoral access in both patients. The male patient had a new bleeding two months later and died. In the female patient an endosonography performed nine months after the procedure showed absence of remaining varices.

A modified microsurgical model for end-to-side selective portacaval shunt in the rat: intraoperative microcirculatory investigations

PURPOSE: To investigate the intraoperative microcirculatory changes of the affected organs (small bowel, liver and kidney) during the making of a modified selective portacaval (PC) shunt. METHODS: On ten anaesthetized Sprague-Dawley rats the selective end-to-side mesocaval anastomosis was performed, where only the rostral mesenteric vein is utilized and the portal vein with the splenic vein are left intact. Morphometric and microcirculatory investigations using a LDF device determining flux units (BFU) were carried out. RESULTS: After completing the shunts the microcirculatory flux values did not recover in the same manner on the surface of the small intestine, the liver or the kidney. BFU values showed deterioration in the small intestine and in the liver (p<0.001). During the reperfusion the BFU values improved, but not in the same manner. The small intestine values left behind the kidney and liver data. CONCLUSIONS: Technically, the advantages of the models include the selective characteristic, the mesocaval localization and the relatively easy access to those vessels. However, its major disadvantage is the time needed for positioning the vessels without coiling or definitive stretching. Intraoperative LDF may provide useful data on the microcirculatory affection of the organs suffering from hypoperfusion or ischemia during creating the shunts.

The development of extrahepatic portacaval shunt device based on magnetic compression technique through the interventional procedure / 中国医疗器械杂志

A device of extrahepatic portacaval shunt is introduced. This device is composed of the daughter and parent magnets and the vascular interventional operation equipment. It is based on the principle of magnetic compression technology, through the intervention approach the daughter and mother magnet are moved to the portal vein and inferior vena cava, respectively. Then the two magnets attract and compress the vessel walls of portal vein and inferior vena cava. Two weeks later, the magnets are detached from the vessel wall with a RUPS-set and the portacaval shunt is established. It is mainly used for the treatment of portal hypertension. It belongs to the interventional operation, there is no any foreign body remaining after the portacaval shunt is established, which can maintain long-term patency. Futhermore the portacaval shunt will not be expanded, therefore it can significantly reduce the incidence of hepatic encephalopathy.

Derivaciones portosistemáticas congénitas: reporte de caso en un canino / Congenital portosystemics shunts: case report in a dog

Las derivaciones portocava extrahepáticas son anomalías vasculares donde la circulación portal se conecta con la circulación sistemática. En los caninos constituyen el 45% de las anomalías portovasculares, registrándose un predisposición racial. El objetivo de este trabajo es presentar los hallazgos ecográficos en un canino de raza Yorkshire. Se observó disminución del tamaño hepático, con la presencia de un vaso anómalo que comunicaba la vena porta con la vena cava, y donde el Doppler color registró turbulencia. Luego de la corrección quirúrgica, se observó un aumento del diámetro de la vena porta, con aumento del tamaño del órgano. En el diagnóstico de las derivaciones vasculares extra hepáticas, la ecografía tiene la ventaja de ser un método no invasivo que da información sobre el parénquima hepático y la vasculatura, sirviendo de guía para la selección de los procedimientos quirúrgicos.

La derivación portocava en la era del TIPS, la endoscopia y los trasplantes de hígado, su utilidad en la hemorragia esofágica aguda: [revisión] / Portocaval shunts in the era of TIPS, endoscopy and liver transplantation: indications in acute esophageal hemorrhage: [review]

Las derivaciones portocava marcaron un hito en el devenir histórico de la cirugía para el manejo de la hipertensión portal. El sangrado por várices esofágicas representa una urgencia quirúrgica que demanda intervención inmediata. El tratamiento de las várices esofágicas por abordaje endoscópico o por TIPS y, por otra parte, el advenimiento del trasplante hepático como un procedimiento estándar, ha disminuido la frecuencia con que se realizan tales derivaciones. Sin embargo, estos procedimientos tienen indicaciones precisas, tanto como intervenciones de urgencia en algunos casos de hemorragia esofágica, como en forma electiva en determinados pacientes con hipertensión portal.Hemos hecho una revisión de la literatura y de los conocimientos actuales de las derivaciones portocava a raíz de un caso tratado en forma exitosa en el Hospital Occidente de Kennedy en Bogotá, Colombia.

Portocaval shunts constitute a milestone in the history of the surgical treatment of portal hypertension. Bleeding from esophageal varices is a surgical emergency that demands immediate intervention. The endoscopic management of esophageal varices and the advent of TIPS, plus the development of liver transplantation have diminished the frequency of the use of portocaval shunts. However, these procedures have precise indications, both as emergency operations in some cases of esophageal varicose hemorrhage as well as elective procedures in selected patients with portal hypertension. We hereby present a literature review of the “state of the art” of portocaval shunts motivated by a patient that was successfully treated at Hospital Occidente de Kennedy in Bogotá, Colombia.

Hemi-portocaval shunt: a simple salvage maneuver for small-for-size graft during living donor liver transplantation: a case report / 中华医学杂志(英文版)

Since the fast expansion of living donor liver transplantation (LDLT) over last few decades, small-for-size syndrome (SFSS) has emerged as a tough problem. Herein the first case of LDLT combined hemi-portocaval shunt in the mainland of China was reported. Portal venous over perfusion was well modulated and the recipient recovered uneventfully. LDLT combined hemi-portocaval shunt was a feasible procedure for preventing SFSS in LDLT.

Derivación portocava transitoria en el trasplante hepático con preservación de la cava / Temporary portocaval shunt in the liver transplant with vena cava preservation

El uso de la derivación portocava durante el trasplante hepático ortotópico mejora la hemodinámica, puede contribuir a reducir los requerimientos de glóbulos y protege la función renal, aunque incrementa moderadamente el tiempo quirúrgico...

The use of the portocaval shunt during the liver orthotopic transplantation improves the hemodynamics, contributes to reduce the requirements of red blood cells and and protects the renal function, although it moderately increases the surgical time...

Management of difficult, severe and recurrent Budd-Chiari syndrome / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the management of complicated, severe or recurrent Budd-Chiari syndrome.</p><p><b>METHODS</b>From February 2004 to August 2007, 28 patients with complicated, severe or recurrent Budd-Chiari syndrome were treated. In this series, 16 patients relapsed after treated with percutaneous transluminal angioplasty or stent deployment, 2 cases relapsed after surgery; and the other 10 were under severe conditions and hard to treat, including malignancy of the inferior vena cava and right atrium. Meso-cavo-atrial shunt was carried out in 10 cases, meso-cavo-jugular shunt in 6 (capitis medusa was used in one case), cavoatrial shunt in 2 and cavo-jugular shunt in 1, mesocaval shunt in 2, and radical or extended radical correction in 7.</p><p><b>RESULTS</b>One patient (3.6%) died in 24 hours after operation. Graft infection occurred in 1 case. Excellent, good, fair, poor and death rate were 22.2%, 55.5%, 14.8%, 3.7% and 3.7%, respectively, the overall effective rate was 92.5%.</p><p><b>CONCLUSION</b>To select personalized treatment according to the disease status brings hopes to difficult, severe, recurrent Budd-Chiari syndrome.</p>

Living-Donor Liver Transplantation with Transient Portacaval Shunt and Splenectomy in a Patient with Small-for-Size Graft and Bleeding Gastric Fundal Varices: A Case Report / 대한이식학회지

Excessive portal venous inflow has been known as a determining factor for hepatic injury in small-for-size graft in living-donor liver transplantation. Partial diversion of portal inflow to the systemic circulation by portacaval shunt has been reported as a promising treatment modality to prevent patient from small-for-size graft syndrome. In addition, splenectomy itself is not only a method to decrease portal flow, but also a treatment for the gastric fundal variceal bleeding. We performed living-donor liver transplantation with transient portacaval shunt and splenectomy due to small-for-size graft in a 50 year-old male suffering from hepatitis B virus related liver cirrhosis with bleeding gastric fundal varices, not amenable to control endoscopically. The donor was patient's wife and a graft to recipient body weight ratio (GRWR) was 0.64. During surgery, left portal vein was used for temporary portacaval shunt and the right portal vein was anatomosed to the graft portal vein. After all vascular anastomoses completed, an endoloop (OpenLoop(R), SJM, Paju, Korea) was placed around portacaval shunt without tightening, and the knot pusher was brought out through abdominal wall introduced in a silastic drain tube. Concomitant splenectomy was performed. Twenty-four hours after transplantation, the loop placed around portacaval shunt was tightened as a bedside procedure. The recipient had an uneventful postoperative course and was discharged with normal graft function 26 days after transplantation. Living-donor liver transplantation with transient portacaval shunt and splenectomy could be an acceptable surgical treatment strategy for patients with end-stage liver disease with small-for-size graft and bleeding gastric fundal varices.

Derivação meso-porta (shunt Rex): tratamento atual da obstrução extra-hepática da veia porta / Meso-portal bypass (Rex shunt): current treatment of extrahepatic portal vein obstruction

Objetivo: Apresentar a caso de uma criança brasileira, provavelmente a primeira, portadora de obstrução extra-hepática da veia porta (OEHVP), submetida ao shunt Rex (derivação cirúrgica meso-porta) para tratamento da hipertensão porta pré-hepatica. Descrição: Menino de um ano e nove meses, 11 kg, previamente hígido, apresentou hematemese e melena. Foi realizada endoscopia digestiva alta, que demonstrou varizes de esôfago sangrantes grau III. Foi iniciado tratamento com propranolol e escleroterapia. Apresentou mais três episódios de sangramento importante e sinais laboratoriais de hiperesplenismo e aumento da amônia sérica. Realizado diagnóstico de cavernoma da veia porta. Foi indicado tratamento cirúrgico, após avaliação da coagulação e biopsia hepática normais. Foi feita opção pela derivação meso-porta ou shunt Rex, que consiste na colocação de um enxerto de veia jugular entre a veia mesentérica superior e o ramo esquerdo intra-hepatico da veia porta, restaurando o fluxo sanguíneo portal para o fígado. O paciente foi submetido com dois anos e seis meses, em março de 2004, à cirurgia no Children's Hospital de Chicago, sem intercorrências, tendo recebido alta no quinto dia pós-operatório. Retornou após um mês da cirurgia ao Brasil, onde seguiu fazendo controles periódicos. Atualmente, quase três anos apos o shunt Rex, o menino tem vida normal, com provas de função hepática normais, sem esplenomegalia, sem varizes e nem sinais de hipertensão porta. O shunt encontra-se pérvio e com bom fluxo pela ultra-sonografia. Conclusões: A cirurgia de derivação mesoporta e uma opção terapêutica recente e, muito provavelmente, tornar-se-á o método de escolha no manejo da hipertensão porta pré-hepática, por OEHVP. É superior aos outros procedimentos cirúrgicos, já que elimina totalmente a hipertensão porta e suas seqüelas.

Effects of hepatotrophic factors on the liver after portacaval shunt in rats with portal hypertension / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Portacaval shunt (PCS) prevent hepatotrophic factors from flowing into the liver, but they enter directly the systemic circulation and worsen liver injury. This study was designed to investigate the effects of hepatotrophic factors through the portal vein on the liver in rats with portal hypertension after portacaval shunt.</p><p><b>METHODS</b>Intrahepatic portal hypertension (IHPH) was induced by intragastric administration of carbon tetrachloride, and end-to-side PCS was performed. Eight normal rats served as controls, and eight rats with IHPH served as IHPH model (IHPH group). Another 32 rats with IHPH-PCS were randomly subdivided into 4 groups: normal saline (NS) given to 8 rats, hepatocyte growth factor (HGF) 8, insulin (INS) 8, hepatocyte growth factor and insulin (HGF + INS) 8. Hepatotrophic factors were infused into the portal vein through an intravenous catheter. Portal venous pressure (PVP) was measured. The levels of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were tested biochemically and those of hyaluronic acid (HA) and laminin (LN) were measured by radioimmunoassay. Hepatic fibrosis was assessed histologically and the expression of collagens type I and III were detected immunohistochemically. Ultrastructural change of hepatocytes and the number of mitochondria were observed under an electron microscope. The data were compared between groups and subgroups by Student-Newman-Keuls procedure with SPSS10.0.</p><p><b>RESULTS</b>PVP was significantly higher in the IHPH rats than in the control rats (P < 0.05). The levels of serum ALT, AST, HA, and LN, hepatic fibrosis score, the amount of collagen deposition, collagens type I and III increased more significantly in the IHPH group than in the control rats (P < 0.05). The number of mitochondria decreased more significantly in the IHPH rats than in the control rats (P < 0.05). The levels of serum ALT, AST, HA and LN as well as hepatic fibrosis score, the amount of collagen deposition, and the amount of collagens type I and III in the HGF and HGF + INS rats were significantly lower than those in the NS rats (P < 0.05). The damage to hepatocyte ultrastructure was markedly alleviated and the number of mitochondria was increased more significantly in the HGF and HGF + INS rats than in the NS rats under an electron microscope.</p><p><b>CONCLUSIONS</b>Perfusion of exogenous hepatotrophic factors through the portal vein can alleviate liver injury, minimize the damage to the ultrastructure of hepatocyte, protect liver function, and lessen hepatic fibrosis in rats with portal hypertension after PCS.</p>

Effects of portaazygous disconnection, portocaval shunt and selective shunts on experimental rat liver cirrhosis / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To evaluate the effects of portaazygous disconnection (PAD), portacaval shunt (PCS) and distal splenocaval shunt (DSCS) on the portosytemic shunting (PSS), hepatic function (HF), hepatic mitochondrial respiratory function (HMRF), oral glucose tolerance test (OGTT) and arterial ketone body ratio (KBR) in order to provide a sound basis for selecting suitable operations for patients.</p><p><b>METHODS</b>Using a cirrhotic portal hypertensive model induced by CCl4/ethanol in Wistar rats, the PSS, HF, HMRF, OGTT and KBR were determined three weeks after PCS, DSCS and PAD.</p><p><b>RESULTS</b>It was revealed that: (1) In the cirrhotic portal hypertension rats, the PSS increased significantly, HMRF and hepatic reserve function (HRF) decreased significantly when compared with the control rats. (2) At the time of first postoperative week, the mean blood glucose value in the 120-minute OGTT in each PAD, PCS and DSCS groups had significant differences compared with the cirrhotic control group. But during the second and third postoperative weeks, the mean blood glucose values in the 120-minute OGTT in both PAD and DSCS groups had no significant differences compared with the cirrhotic control group except for the PCS group. The values of KBR in the three operative groups decreased significantly compared with the cirrhotic control group during the two postoperative weeks. In the third postoperative week, only the values of KBR in the PCS group had a significant difference compared with the cirrhotic control group. (3) After PCS, the PSS was further increased; HF and HMRF were significantly decreased. Little improvement was found in the third postoperative week. (4) After DSCS and PAD, the above mentioned indices were less influenced, and they were restored more quickly than those in the PCS group.</p><p><b>CONCLUSION</b>We found that PAD and DSCS are more desirable than PCS.</p>

Small-diameter H-graft portacaval shunt for variceal hemorrhage: experience at King Chulalongkorn Memorial Hospital.

BACKGROUND: Portosystemic shunts remain to be a good means for preventing recurrent variceal hemorrhage in a certain number of patients who fail to respond to other therapeutic modalities. Total portal decompression is no longer recommended owing to the high incidence of postoperative encephalopathy and liver failure. Distal splenorenal shunt is too technically demanding. A small-diameter H-graft portacaval shunt (SDHGPCS) which partially decompresses the portal system and was popularized by Sarfeh et al and associates in 1983 seems to be a good alternative for its simplicity to construct and impressive results. PATIENTS AND METHOD: SDHGPCS with an 8 mm. PTFE graft has been performed to prevent recurrent variceal hemorrhage in cirrhotic patients who failed to respond to long term pharmacotherapy and endoscopic therapy during the last 3 years at our institution. Data analysis included: causes of cirrhosis, patients' Child-Pugh classification, operative time, operative blood transfusion, and results of treatment. RESULTS: Nine cirrhotic patients were entered into the present study. Three patients (33.3%) were in Child-Pugh class A and 6 (66.7%) were in Child-Pugh class B. Three patients had ringed PTFE grafts and 6 had non-ringed PTFE grafts. The operative time ranged from 225 to 420 minutes (mean 303, median 285 minutes). There was no perioperative (30 days) death. One postoperative intraabdominal hemorrhage was successfully treated by relaparotomy. Two patients were lost to follow up at 3 and 10 months after the operations. Four patients are alive and well at 12, 24, 30 and 35 months after the operations. One patient developed hepatic encephalopathy at 35 months postoperation which was thought to be secondary from progression of the hepatic parenchymal disease. One patient developed recurrent variceal hemorrhage at 30 months postoperation from portal vein thrombosis and was successfully treated by endoscopic variceal sclerotherapy (EVS). One patient died from carcinoma of the larynx 3 months after SDHGPCS and 2 died from end stage liver disease at 30 and 45 months after SDHGPCS. CONCLUSION: SDHGPCS is an effective mean to prevent recurrent variceal hemorrhage. The procedure is simple and practical to perform in hospitals with low volume of portosystemic shunt operations. The authors recommended SDHGPCS as an alternative in prevention of recurrent variceal hemorrhage in cirrhotic patients who fail to respond to other therapeutic modalities.

Small-diameter prosthetic H-graft portacaval shunts in the treatment of portal hypertension / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Portasystemic shunts, especially total shunts, are effective tools for reducing portal pressure and controlling variceal bleeding but lead to high risk of encephalopathy and accelerating liver failure. The purpose of this study is to evaluate the clinical effects of small-diameter expanded polytetrafluoroethylene (ePTFE) H-graft portacaval shunts in the treatment of portal hypertension.</p><p><b>METHODS</b>Thirty-one patients with portal hypertension were treated with ePTFE small-diameter H-graft portacaval shunts from December 1995 to April 2002. Twenty-one had externally ringed grafts and 10 had non-ringed grafts; 20 had 10 mm diameter grafts and 11 had 8 mm grafts. The left gastric artery and coronary vein were ligated in 22 patients. Additionally, 6 patients underwent pericardial devascularization, and splenectomies were performed on 30 patients.</p><p><b>RESULTS</b>An average decrease of free portal pressure (FPP) from (32.13 +/- 4.86) cmH2O before shunting to (12.55 +/- 5.57) cmH2O after shunting was observed. Portal blood flow was reduced by 1/3 compared with the levels measured before shunting. Twenty-eight patients survived after the operation, and no upper gastrointestinal rebleeding occurred in the follow-up period (40.2 months on average). We lost contact with one patient. Color Doppler ultrasonography and/or portography revealed the shunts to be patent in 28 cases and occluded in 2 (6.4%) cases. Encephalopathy developed in 4 patients (12.9%).</p><p><b>CONCLUSION</b>Small-diameter ePTFE H-graft portacaval shunts can effectively reduce portal pressure. Moreover, the majority of the hepatopetal flow from the portal vein can be adequately maintained. The reinforced shunts may achieve a higher rate of patency. Morbidity from encephalopathy was less frequent than in patients receiving total shunts. Small-diameter H-graft portacaval shunts are also effective in preventing recurrent variceal bleeding.</p>

Alterações bioquímicas e morfológicas após anastomose porto-cava e hepatectomia parcial. Estudo experimental em cães / Biochemical and morphological alterations after portocaval shunt and partial hepatectomy: experimental study in dogs

OBJETIVO: Estudar os efeitos da anastomose porto-cava sobre a morfologia e bioquímica do fígado de cães. MÉTODOS: Vinte animais foram divididos em 2 grupos: o Grupo I foi submetido à hepatectomia parcial de 28,7 por cento e o Grupo II, à hepatectomia parcial associada à derivação porto-cava. Os parâmetros analisados foram: peso corpóreo, colesterol e triglicérides plasmáticos, lipídios e glicogênio hepáticos e índice ponderal de regeneração hepática. Os dados foram analisados no pré-operatório e no 30° dia do pós-operatório. RESULTADOS: No Grupo I, apenas os lipídios hepáticos estavam significativamente elevados 30 dias após a cirurgia. No Grupo II, o colesterol plasmático e o glicogênio hepático apresentaram redução no pós-operatório, enquanto os lipídios hepáticos estavam significativamente elevados. Comparando-se os 2 grupos, houve diferença estatisticamente significativa nos valores do colesterol plasmático, do glicogênio e do índice de regeneraçãohepática. CONCLUSÃO: A anastomose porto-cava causa prejuízos morfológicos e bioquímicos significativos ao fígado, além de redução significativa do peso corpóreo.

Inferior meso-caval shunt for portal hypertension with bleeding esophageal varices.

We report a 12-year-old boy with cavernomatous malformation of the portal vein who presented with repeated hematemesis. Inferior meso-caval shunt was performed to decompress the portal hypertension. There was minimal dissection and disturbance of periportal collateral channels in comparison to using the superior mesenteric vein. One year later, esophagoscopy showed no varices, and he has had no further episode of bleed.

Venous Complications after Pediatric Liver Transplantation / 대한이식학회지

PURPOSE: We performed this study to assess the incidence of venous complications, including portal vein and hepatic vein stenosis, in both split cadaveric and living donor liver transplants and to assess the diagnostic and therapeutic modalities of these lesions. METHODS: Seventy-six liver transplantations were performed in 75 children with split (5) or living donor (71) graft between December 1994 and March 2002. Patients' data were analyzed retrospectively with special emphasis on venous complications. RESULTS: Venous complications occurred in 14 patients (18.6%) including hepatic vein stenosis in 8, portal vein stenosis in 4, portal vein thrombosis in 1, and combined portal vein thrombosis and hepatic artery stenosis in 1 patient. Venous complications were accompanied by abnormality of liver fuction, ascites, progressed splenomegaly, and gastrointestinal bleeding. To diagnose the venous complications, Doppler ultrasonography was performd at first, and those were confirmed by angiography or CT. Hepatic vein stenosis was managed by percutaneous transhepatic angioplasty (6), angioplasty followed by reposition of graft (1), and supportive care only 1 patient. Portal vein complications were managed by angioplasty (4), angioplasty followed by mesocaval shunt (1), and combined revascularization and angioplasty (1). The overall survival rate was 86% (12 of 14 patients). CONCLUSION: Close surveillance of the complication of vascular anastomoses and multidisciplinary approach to treat of venous complication after pediatric liver transplantation have made it possible to reduce the graft loss and mortality. Aggressive and successful radiologic intervention should be considered to eliminate the need for surgical revision, portacaval shunting or retransplantation.