BackTable Vascular & Interventional Ep. 572 How to Perform Mesocaval Shunts: Techniques & Outcomes with Dr. Omar Chohan and Dr. Harris Chengazi
Sep 12, 2025
Join interventional radiologists Dr. Omar Chohan and Dr. Harris Chengazi as they explore the evolving role of mesocaval shunts for managing portal hypertension. They discuss patient selection, highlighting challenging cases like autoimmune hepatitis and pancreatic cancer. The conversation dives into meticulous planning using advanced imaging tools like the 4D CT scanner and emphasizes the importance of compassion in patient care. These experts share insights on overcoming procedural challenges to improve quality of life for their patients.
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When Mesocaval Shunts Are Indicated
- Mesocaval shunts repurpose an old surgical approach by connecting the SMV (or its collaterals) to the IVC when TIPS is not feasible.
- They work best when the portal vein is inaccessible or disease is presinusoidal, offering an alternate decompression route.
Patient With Autoimmune Hepatitis
- A young woman with autoimmune hepatitis required biweekly large-volume paracenteses for years and agreed to a mesocaval attempt to improve quality of life.
- After shunt creation she dramatically reduced paracentesis frequency and regained function enough to relocate.
Screen Candidates Like TIPS
- Do screen candidates like you would for TIPS: check MELD and baseline functional status and avoid very high MELD unless creatinine-driven.
- Assess encephalopathy and cardiac reserve because direct return to the IVC can worsen these conditions.