BackTable Vascular & Interventional Ep. 572 How to Perform Mesocaval Shunts: Techniques & Outcomes with Dr. Omar Chohan and Dr. Harris Chengazi
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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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Balloon-Guided DIPS Technique
- When using the DIPS-style puncture, inflate a balloon in the SMV collateral and aim the IVC needle toward that balloon to confirm through-and-through access.
- Once balloon pops, quickly advance a long exchange 0.035 wire and pull the balloon back to establish floss access.
Choose Covered+Uncovered Stent Strategy
- Use a Viatorr (covered + uncovered) strategy: cover the IVC tract but leave an uncovered distal portion in mesenteric veins to preserve collaterals.
- Balloon to your target diameter (they typically post-dilate to 8 mm initially) and monitor for encephalopathy after decompression.
IVC Occlusion Complication
- After extending a covered stent into a tight IVC, they accidentally occluded the IVC and caused alarming labs from femoral blood draws.
- The team returned emergently and placed an IVC venous stent alongside the shunt to restore flow and the patient recovered.