Pediatr Surg Int. 2026 Jul 12;42(1):298. doi: 10.1007/s00383-026-06531-2.
ABSTRACT
PURPOSE: Shunt thrombosis is an important complication after proximal splenorenal shunt (PSRS) in children with extrahepatic portal vein thrombosis (EHPVT). We evaluated whether preoperative vascular parameters are associated with postoperative PSRS patency.
METHODS: Of 139 non-cirrhotic patients who underwent PSRS for EHPVT, 86 with adequate preoperative imaging and follow-up were included in this retrospective single-center study. The aortomesenteric angle, splenic and left renal vein diameter were measured on preoperative CT, and spontaneous splenorenal shunt presence was recorded. Shunt patency was assessed from postoperative imaging. Correlation, Firth penalized logistic regression, and ROC analyses were performed.
RESULTS: Mean age was 114 ± 50 months; mean follow-up 81 ± 51 months. Patency was preserved in 69 patients (80.2%) and 17 (19.8%) developed thrombosis. No parameter was associated with patency: aortomesenteric angle (r = 0.035), splenic vein diameter (r = 0.039), left renal vein diameter (r = 0.111), or spontaneous splenorenal shunt (r = 0.005) (all p > 0.05). Firth regression identified no independent predictors, and the aortomesenteric angle showed non-significant discrimination (AUC = 0.64, 95% CI 0.485-0.795, p = 0.076).
CONCLUSION: Preoperative vascular parameters were not associated with postoperative PSRS patency in pediatric EHPVT. Static anatomical measurements have limited predictive value for shunt outcomes.
PMID:42437424 | DOI:10.1007/s00383-026-06531-2