Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2020; 8(22): 5555-5563
Published online Nov 26, 2020. doi: 10.12998/wjcc.v8.i22.5555
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
Processing time: 97 Days and 14 Hours
Abstract
BACKGROUND

The Rex shunt was widely used as the preferred surgical approach for cavernous transformation of the portal vein (CTPV) in children that creates a bypass between the superior mesenteric vein and the intrahepatic left portal vein (LPV). This procedure can relieve portal hypertension and restore physiological hepatopetal flow. However, the modified procedure is technically demanding because it is difficult to make an end-to-end anastomosis of a bypass to a hypoplastic LPV. Many studies reported using a recanalized umbilical vein as a conduit to resolve this problem. However, the feasibility of umbilical vein recanalization for a Rex shunt has not been fully investigated.

AIM

To investigate the efficacy of a recanalized umbilical vein as a conduit for a Rex shunt on CTPV in children by ultrasonography.

METHODS

A total of 47 children who were diagnosed with CTPV with prehepatic portal hypertension in the Second Hospital, Cheeloo College of Medicine, Shandong University, were enrolled in this study. Fifteen children received a recanalized umbilical vein as a conduit for a Rex shunt surgery and were enrolled in group I. Thirty-two children received the classic Rex shunt surgery and were enrolled in group II. The sonographic features of the two groups related to intraoperative and postoperative variation in terms of bypass vessel and the LPV were compared.

RESULTS

The patency rate of group I (60.0%, 9/15) was significantly lower than that of group II (87.5%, 28/32) 7 d after (on the 8th d) operation (P < 0.05). After clinical anticoagulation treatment for 3 mo, there was no significant difference in the patency rate between group I (86.7%, 13/15) and group II (90.6%, 29/32) (P > 0.05). Moreover, 3 mo after (at the beginning of the 4th mo) surgery, the inner diameter significantly widened and flow velocity notably increased for the bypass vessels and the sagittal part of the LPV compared to intraoperative values in both shunt groups (P < 0.05). However, there was no significant difference between the two surgical groups 3 mo after surgery (P > 0.05).

CONCLUSION

For children with hypoplastic LPV in the Rex recessus, using a recanalized umbilical vein as a conduit for a Rex shunt may be an effective procedure for CTPV treatment.

Keywords: Cavernous transformation of the portal vein; Rex shunt; Recanalization; Umbilical vein; Ultrasonography

Core Tip: Recanalized umbilical vein as a conduit for a Rex shunt was recently used to treat cavernous transformation of the portal vein. Fifteen children who received a recanalized umbilical vein as a conduit for a Rex shunt were included in group I, and the remaining 32 children who received a classic Rex shunt were included in group II. There was no difference in patency rate between the two groups after 3 mo of treatments. Diameter and flow velocity of bypass vessels in both two groups increased, and blood flow into the liver of both groups increased 3 mo after surgery.