Pediatric liver cirrhosis interventional procedures: from biopsy to transjugular intrahepatic portosystemic shunt

Abstract

Cirrhosis is a complex diffuse process whereby the architecture of the liver is replaced by abnormal nodules because of the presence of fibrosis. Several pediatric diseases such as extrahepatic portal vein obstruction, biliary atresia, alpha-1-antitrypsin deficit and autoimmune hepatitis can lead to cirrhosis and portal hypertension in children. In this article the authors describe interventional radiology procedures that can facilitate the diagnosis and treatment of diseases associated with liver cirrhosis and portal hypertension in the pediatric population. These procedures include image-guided liver biopsy, mesenteric–intrahepatic left portal vein shunts, balloon-occluded retrograde transvenous obliteration, transjugular intrahepatic portosystemic shunts and splenic embolization.

Pathophysiology, Diagnosis, and Management of Portal Hypertension in the Pediatric Population

“…It can be performed percutaneously with ultrasound guidance or through transjugular access. 26 27 For percutaneous liver biopsy with ultrasound guidance, certain preprocedural laboratory values are required; these include an INR ≤1.5 and platelet counts > 50,000 unit/mm 3 . At our institution, a coaxial biopsy needle system is typically used for percutaneous biopsy.…”