Before the advent of TIPS, mesocaval shunts were considered a less popular option for managing portal hypertension. But today, could they serve as a lifeline when no other choices remain? This week on BackTable, Drs. Omar Chohan and Harris Chengazi (Great Lakes Medical Imaging) join host Dr. Chris Beck to discuss the evolving role of endovascular mesocaval shunts, covering patient selection, clinical decision-making, and technical pearls.

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SYNPOSIS

In this episode, the hosts delve into the specialized procedure of meso-caval shunts, focusing on its applications for patients with portal hypertension who have no other viable options. This discussion includes detailed case studies, such as one involving a woman with autoimmune hepatitis and another with pancreatic cancer, showcasing the practical challenges and innovative solutions in creating these shunts. In each case, they detail the rationale for patient selection, difficult anatomy, procedural steps, and resolution of symptoms like recurrent ascites and variceal bleeding. The episode emphasizes the importance of pre-procedure planning, collaboration, and precise imaging, utilizing advanced tools like the 4D CT scanner. The conversation also highlights the compassionate motivation behind these complex procedures, aimed at improving patients' quality of life.

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TIMESTAMPS

00:00 - Introduction
03:07 - Historical Context and Indications
06:49 - Case 1: Patient with Refractory Ascites
34:00 - Case 2: Recurrent GI Bleeding
41:16 - Case 3: TIPS Consult - Pancreatic Cancer and Duodenal Varices
47:44 - Lessons, Pearls, and Tips
56:13 - Final Thoughts

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RESOURCES

A Case Series of Dr. Chengazi's Mesocaval Shunts on X:
https://x.com/chengazimd/status/1966337167879438571

Episode 573 Portal Hypertension Treatment Strategies:
https://www.backtable.com/shows/vi/podcasts/473/portal-hypertension-treatment-strategies-ir-hepatology-perspectives

TIPS University Freshman Year:
https://www.backtable.com/shows/vi/podcasts/123/tips-university-freshman-year-referrals-pre-op-workup

TIPS University Sophomore Year:
https://www.backtable.com/shows/vi/podcasts/124/tips-university-sophomore-year-basic-procedure-technique

TIPS University Junior Year:
https://www.backtable.com/shows/vi/podcasts/125/tips-university-junior-year-advanced-techniques-ice-splenic-access

TIPS University Senior Year:
https://www.backtable.com/shows/vi/podcasts/126/tips-university-senior-year-gunsight-technique-splenic-closure