Interventional Radiology Management of Pediatric Portal Venous Pathologies

Portal venous pathology is a leading cause of prehepatic portal hypertension in children, most often resulting from portal vein thrombosis (PVT), either in the native liver or following liver transplantation. While surgical shunts such as the Meso-Rex shunt and Warren shunt remain the first-line therapy, interventional radiology (IR) now plays a central role in primary and adjunctive treatment strategies. This review outlines current IR techniques for managing pediatric portal venous disorders. These include portal vein recanalization (PVR), salvage of thrombosed Meso-Rex and Warren shunts, and transjugular intrahepatic portosystemic shunt (TIPS) placement. Technical aspects are emphasized, including pediatric-specific access strategies (eg, translienal puncture, CBCT guidance, wire targeting, and stent selection), and outcome data are presented where available.