PMC9985502_01
Maximum intensity projection contrast enhanced computed tomography showing the anatomical relationship between the transplant portocaval shunt (PCS), inferior vena cava (IVC), and the massive splenorenal shunt (SRS).
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Abdominal computed tomography (CT) showed no identifiable main portal vein, and there was cavo-portal transposition and a persistently large splenorenal shunt (Figure 1).
Contrast-enhanced CT showing both the large splenorenal shunt (SRS) draining the superior mesenteric vein (SMV) and splenic vein (SV) into the left renal vein (LRV) and the small transplant portal vein (PV) anastomosed to the inferior vena cava (IVC).
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Thus, there was no physical connection between splanchnic circulation and liver (Figure 2).
a & b: portal vein access. Challenging and relatively central access is due to diminutive portal vein branches. Intravascular ultrasound guidance.
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A few days later, the patient underwent porto-portacaval shunt via stent placement from the native portal vein stump to the transplant portocaval shunt (Figure 3).
Newly established hepatopedal flow. Although, persistent high flow via the SRS.
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Predominant and retrograde flow remains extending from the portal system via the splenorenal shunt into the renal vein-IVC (Figure 4).