Non-anatomical revascularization of the portal vein in children with non-cirrhotic extrahepatic portal vein obstruction

Portal hypertension resulting from non-cirrhotic extrahepatic portal vein obstruction is a cause of severe morbidity related to variceal bleeding in children. In patients not eligible for Meso-Rex bypass, rescue interventions for refractory variceal bleeding have traditionally included surgical porto-systemic shunts or transjugular intrahepatic porto-systemic shunt (TIPS), which alter the normal physiology of liver perfusion and expose children to long-term complications. Portal vein recanalization is a recently described technique which aims to restore the hepatopetal flow through the native portal system but its feasibility is often limited. We aim to present two innovative techniques of percutaneous non-anatomical portal vein recanalization for treating non-cirrhotic extrahepatic portal vein obstruction in children who failed anatomical revascularization.