Yang Yang,Lyu Zhenyu,Wang Zhiyuan,et al.Clinical application of transjugular wedge hepatic venography with retrograde portal venography in preoperative evaluations for cavernous transformation of the portal vein[J].Journal of Clinical Pediatric Surgery,,():867-871.[doi:10.3760/cma.j.cn101785-202505020]
Click Copy

Clinical application of transjugular wedge hepatic venography with retrograde portal venography in preoperative evaluations for cavernous transformation of the portal vein

Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R] volume: Number: 2026 09 Page: 867-871 Column: 论著 Date of publication: 2026-09-22
Author(s):
Yang Yang1;  Lyu Zhenyu1;  Wang Zhiyuan1;  Wang Zengmeng2;  Peng Chunhui2;  Wu Dongyang2;  Cao Yongli3;  Xiao Yanyan1
1 Department of Cardiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China;
2 Department of General Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China;
3 Department of Radiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
Keywords:
Jugular Vein; Portal Venography; Child
DOI:
10.3760/cma.j.cn101785-202505020
Abstract:
Objective To explore the clinical value and interventional procedural techniques of transjugular wedge hepatic vein retrograde portography for preoperative evaluation in children with portal cavernous transformation.Methods Twenty-five children with portal cavernous transformation admitted from January 2021 to December 2024 were recruited.The cohort comprised 12 boys and 13 girls with a mean age of (91.74±40.44) month at admission.Transjugular wedge hepatic vein retrograde portography and contrast-enhanced computed tomography (CT) were performed.The study focused upon route selection,operational experience and interpretation of results for retrograde portography.The findings were compared with contrast-enhanced CT and validated by intraoperative surgical exploration for evaluating the accuracy of this method in assessing intrahepatic portal vein development and Rex vessel status in children.Results Based upon the Bertocchini classification,angiography revealed type A (n=11),type B (n=7),type C (n=1),type D (n=3) and type E (n=3).Retrograde wedge angiography offered more distinct and accurate visualization of Rex vessels,intrahepatic portal vein patency and anatomical pathways as compared with contrast-enhanced CT.Types A,B and C successfully underwent Rex vessel dissection and bypass grafting during surgery.Conclusions In children with portal cavernous transformation,transjugular wedge hepatic vein retrograde portography via a jugular approach proves a simpler procedure.It clearly delineates Rex vessel status and intrahepatic left/right portal vein patency during enhanced CT evaluation of abdomen.It assists surgeons in selecting appropriate surgical approaches.The above method is a safe,effective,and accurate preoperative assessment tool.

References:

[1] Ruan ZM,Wu M,Shao CC,et al.Effects of Rex-bypass shunt on the cavernous transformation of the portal vein in children:evaluation by the color Doppler ultrasonography[J].Insights Imaging,2020,11(1):4.DOI:10.1186/s13244-019-0815-6.
[2] de Ville de Goyet J,Clapuyt P,Otte JB.Extrahilar mesenterico-left portal shunt to relieve extrahepatic portal hypertension after partial liver transplant[J].Transplantation,1992,53(1):231-232.
[3] Kathemann S,Lainka E,Ludwig JM,et al.Imaging of the intrahepatic portal vein in children with extrahepatic portal vein thrombosis-Comparison of magnetic resonance imaging and retrograde portography[J].J Pediatr Surg,2019,54(8):1686-1690.DOI:10.1016/j.jpedsurg.2018.10.049.
[4] Lawson AJ,Rischbieter P,Numanoglu A,et al.Imaging the Rex vein preoperatively using wedged hepatic venous portography[J].Pediatr Radiol,2011,41(10):1246-1249.DOI:10.1007/s00247-011-2188-y.
[5] Carollo V,Marrone G,Cortis K,et al.Multimodality imaging of the Meso-Rex bypass[J].Abdom Radiol (NY),2019,44(4):1379-1394.DOI:10.1007/s00261-018-1836-1.
[6] Marra P,Dulcetta L,Carbone FS,et al.The role of imaging in portal vein thrombosis:from the diagnosis to the interventional radiological management[J].Diagnostics (Basel),2022,12(11):2628.DOI:10.3390/diagnostics12112628.
[7] Wu HY,Zhou N,Lu LW,et al.Value of preoperative computed tomography for meso-Rex bypass in children with extrahepatic portal vein obstruction[J].Insights Imaging,2021,12(1):109.DOI:10.1186/s13244-021-01057-8.
[8] Bertocchini A,Falappa P,Grimaldi C,et al.Intrahepatic portal venous systems in children with noncirrhotic prehepatic portal hypertension:anatomy and clinical relevance[J].J Pediatr Surg,2014,49(8):1268-1275.DOI:10.1016/j.jpedsurg.2013.10.029.
[9] Elkrief L,Houssel-Debry P,Ackermann O,et al.Portal cavernoma or chronic non cirrhotic extrahepatic portal vein obstruction[J].Clin Res Hepatol Gastroenterol,2020,44(4):491-496.DOI:10.1016/j.clinre.2020.03.016.
[10] de Franchis R,Bosch J,Garcia-Tsao G,et al.Baveno VII-renewing consensus in portal hypertension[J].J Hepatol,2022,76(4):959-974.DOI:10.1016/j.jhep.2021.12.022.
[11] Khanna R,Sarin SK.Noncirrhotic portal hypertension:current and emerging perspectives[J].Clin Liver Dis,2019,23(4):781-807.DOI:10.1016/j.cld.2019.07.006.
[12] Hwang M,Thimm MA,Guerrerio AL.Detection of cavernous transformation of the portal vein by contrast-enhanced ultrasound[J].J Ultrasound,2018,21(2):153-157.DOI:10.1007/s40477-018-0288-3.
[13] Li L,Zhang JS,Chen Z,et al.Portal-to-right portal vein bypass for extrahepatic portal vein obstruction[J].J Pediatr Surg,2018,53(7):1403-1407.DOI:10.1016/j.jpedsurg.2017.10.059.

Memo

收稿日期:2025-5-13。
通讯作者:肖燕燕,Email:xiaoyanyan00@sina.com

Last Update: 1900-01-01