Wedged hepatic vein portovenography for assessment of Rex vein patency in children with extrahepatic portal venous obstruction.
J Pediatr Gastroenterol Nutr
; 79(2): 213-221, 2024 Aug.
Article
en En
| MEDLINE
| ID: mdl-38847238
ABSTRACT
BACKGROUND:
Meso-Rex bypass is the surgical intervention of choice for children with extrahepatic portal vein obstruction (EHPVO). Patency of Rex vein, umbilical recessus of the portal vein, is a prerequisite for this surgery. Conventional diagnostic modalities poorly detect patency, while transjugular wedged hepatic vein portography (WHVP) accurately detects patency in 90%.OBJECTIVES:
We aimed to assess Rex vein patency and portal vein branching pattern in children with EHPVO using transjugular WHVP and to identify factors associated with Rex vein patency.METHODS:
Transjugular WHVP was performed in 31 children with EHPVO by selective cannulation of left and right hepatic veins. Rex vein patency, type of intrahepatic portal venous anatomy (Types A-E), and factors associated with patency of Rex vein were studied.RESULTS:
The patency of Rex recess on transjugular WHVP was 29%. Complete obliteration of intrahepatic portal venous radicles was the commonest pattern (Type E, 38.7%) while Type A, the favorable anatomy for meso-Rex bypass, was seen in only 12.9%. Patency of the Rex vein, but not the anatomical pattern, was associated with younger age at evaluation (patent Rex 6.6 ± 4.9 years vs. nonpatent Rex 12.7 ± 3.9 years, p = 0.001). Under-5-year children had a 12 times greater chance of having a patent Rex vein (odds ratio 12.22, 95% confidence interval 1.65-90.40, p = 0.004). Patency or pattern was unrelated to local factors like umbilical vein catheterization, systemic thrombophilia, or disease severity.CONCLUSION:
Less than one-third of our pediatric EHPVO patients have a patent Rex vein. Younger age at evaluation is significantly associated with Rex vein patency.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Vena Porta
/
Grado de Desobstrucción Vascular
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Portografía
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Venas Hepáticas
Límite:
Adolescent
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Child
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Child, preschool
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Female
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Humans
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Infant
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Male
Idioma:
En
Año:
2024
Tipo del documento:
Article