Controlled flow reduction of an iliacoportal shunt graft for portal vein arterialization in a pediatric patient

Portal vein arterialization is a rarely used, temporary surgical salvage solution to prevent biliary and hepatic ischemia and necrosis in acute liver de-arterialization. However, it can induce portal hypertension, causing increased morbidity and mortality. We report the case of a 5-year-old girl with portal hypertension and right ventricle volume overload following the creation of an iliacoportal shunt graft for portal vein arterialization due to vessel-adhering neuroblastoma. Partial shunt graft closure was accomplished by placing a stent graft in an hourglass configuration via the right femoral artery using two slender-sheaths in a line with the second more distal than the first. Subsequently, the patient’s symptoms of right ventricle volume overload and portal hypertension decreased. In conclusion, endovascular reduction of elevated portal blood flow after portal vein arterialization is feasible, even in pediatric patients. Graphical abstract