Type:
Educational Exhibit
Keywords:
Varices, Cirrhosis, Venous access, Surgery, Shunts, CT, Veins / Vena cava, Gastrointestinal tract, Abdomen
Authors:
E. Guseva, D. V. Burenchev, S. Morozov, N. Ledikhova, G. V. Manukyan; Moscow/RU
DOI:
10.26044/ecr2019/C-2139
Findings and procedure details
Nowadays the planning and patency of surgical portosystemic shunts is estimated on the CT in the late arterial,
portal,
venous phases and 3D reconstruction.
Before the surgery,
CT is used for predicting the type of surgery.
Radiologist have to report:
- Diameter and patency of portal,
splenic,
mesenteric,
renal vein (especially the entry of the left renal vein) (Fig.2).
- Topography of the splenic vein - position relative to the pancreas,
distance to the left renal vein (Fig.3).
- Patency of the inferior vena cava and absence of its compression (Fig.4).
- Diameter and patency of hepatic vein (important for TIPS surgery)
- The presence of spontaneous splenorenal shunt and its size (for BRTO and CARTO surgery) (Fig.5).
- The presence of a functioning umbilical vein (Fig.6).
- In the case of the main veins occlusion - the presence of venous collateral vessels which diameter more than 1 cm,
suitable for shunting.
After surgery,
the surgeons are interested in the patency of surgical portosystemic shunts (Fig.7).