Efficacy and Safety of Surgical Ligation versus Endovascular Embolization for Type II Congenital Extrahepatic Portosystemic Shunt

Figure 2

Images in a 3-year-old girl diagnosed with type II CEPS with hepatic encephalopathy (HE) who underwent surgical ligation due to large portal vein-IVC shunt. (a) Virtual reality (VR) images reconstructed from computed tomographic angiography (CTA) data prior to ligation. Anteroposterior view shows the portal vein and its branches (green), inferior vena cava (IVC) (blue), and the patent shunt communicating portal vein and IVC (red). (b) Posteroanterior VR image shows the portal vein and its branches (green), IVC (blue), and the portocaval shunt (red). (c) Axial CT image shows the large portal vein-IVC shunt (black arrow) and hepatic adenoma (circle) diagnosed by biopsy. (d) Axial contrast-enhanced CT image shows hypoplastic intrahepatic portal veins (white arrow) preoperative. (e) Indirect portal venography via the superior mesenteric artery (SMA) demonstrates venous outflow of the superior mesenteric vein (SMV) through the shunt (black arrow) drained into IVC (curved arrow), main portal vein (white arrow), and hypoplastic intrahepatic portal vein branches (arrowhead) which are visible. (f) Portal venography with balloon occlusion shows fine main portal vein (white arrow) and hypoplastic intrahepatic portal vein branches (arrowhead). The portal venous pressure (PVP) is 14.7 and 16.5 mmHg before and 15 min after balloon occlusion, respectively. (g) Contrast-enhanced CT images demonstrate the intrahepatic portal veins at 1 month after surgical ligation. (h) CT scan shows the intrahepatic portal veins at 12 months after surgical ligation. (i) CT scan shows the intrahepatic portal veins at 60 months after surgical ligation; the portal vein grows well over time.

(a)

(b)

(c)

(d)

(e)

(f)

(g)

(h)

(i)