Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Sonographic features of umbilical vein recanalization for a Rex shunt on cavernous transformation of portal vein in children
Yu-Qing Zhang, Qing Wang, Mei Wu, Ya Li, Xiu-Liang Wei, Fei-Xue Zhang, Yan Li, Guang-Rui Shao, Juan Xiao
Yu-Qing Zhang, Mei Wu, Ya Li, Xiu-Liang Wei, Fei-Xue Zhang, Department of Ultrasound, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong Province, China
Qing Wang, Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
Yan Li, Department of Nuclear Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong Province, China
Guang-Rui Shao, Department of Radiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong Province, China
Juan Xiao, Center of Evidence-Based Medicine, Institute of Medical Sciences, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong Province, China
Author contributions: Zhang YQ wrote the manuscript, performed procedures and analyzed the data; Wang Q wrote the manuscript, drafted conception and helped design the research; Wu M designed the research, performed examinations and revised the manuscript; Li Y, Wei XL, Zhang FX, Li Y and Shao GR collected and interpreted data; Xiao J analyzed the data; All authors participated in performing the research.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of The Second Hospital, Cheeloo College of Medicine, Shandong University, No. KYLL-2020(LW)-050.
Informed consent statement: The legal guardians of all study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors state that they have nothing to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Mei Wu, MD, PhD, Associate Professor, Department of Ultrasound, The Second Hospital, Cheeloo College of Medicine, Shandong University, No. 247 Beiyuan Street, Jinan 250033, Shandong Province, China. a_may0212@163.com
Received: August 20, 2020
Peer-review started: August 20, 2020
First decision: September 13, 2020
Revised: September 16, 2020
Accepted: October 1, 2020
Article in press: October 1, 2020
Published online: November 26, 2020
ARTICLE HIGHLIGHTS
Research background
The Rex shunt can restore hepatopetal flow and relieve portal hypertension by creating a bypass from the superior mesenteric vein to the intrahepatic left portal vein (LPV) in children with cavernous transformation of the portal vein (CTPV). Compared to traditional surgery, the problem of high risks of recurrence and liver damage can be better resolved. However, the improved shunt with an alternative conduit is technically demanding due to its difficulty in end-to-end anastomosis between a bypass graft and a hypoplastic LPV in the Rex recessus. Nevertheless, the feasibility of a recanalized umbilical vein as a replaceable conduit for a Rex shunt in pediatric patients with a hypoplastic LPV has not been fully explored.
Research motivation
We retrospectively studied the application of a Rex shunt with a recanalized umbilical vein for the treatment of pediatric CTPV along with a postoperative evaluation by ultrasonography to provide useful evidence for the surgical option.
Research objectives
To investigate the efficacy of a recanalized umbilical vein as a conduit for a Rex shunt on CTPV in children using ultrasonography.
Research methods
A total of 47 children who were diagnosed with CTPV with portal hypertension were enrolled, including 15 children who received a recanalized umbilical vein as a conduit for a Rex shunt (group I), and 32 children received the classic Rex shunt (group II). The pre- and postoperative ultrasonic results associated with prognosis were compared between the two groups.
Research results
The Rex shunt with a recanalized umbilical vein achieved a similar postoperative outcome to the classic Rex shunt, confirming the availability of this modified procedure.
Research conclusions
The improved Rex shunt using a recanalized umbilical vein was an effective approach to treat CTPV in children with a hypoplastic LPV. Meanwhile, ultrasonography can be a reliable imaging modality for the assessment of surgical results.
Research perspectives
In this study, we focused on the feasibility of this modified Rex procedure in the treatment of pediatric CTPV. However, further long-term follow-up remains to be performed.
