Pediatric Portal Hypertension Interventions: Ectopic Varices, Portal Vein Recanalization, Portosystemic Shunt Creation, and Maintenance of Surgical Shunts

Management of portal hypertension (PHTN) in pediatric patients presents challenges due to the smaller anatomy and a lack of standardized protocols. While evidence for endovascular management of ectopic varices, maintenance of surgical shunts, portal venous recanalization, and percutaneous portosystemic shunt creation in children grows, adaptation requires specialized techniques and equipment. This review explores the etiologies of pediatric PHTN, including Budd-Chiari syndrome, congenital anomalies, extrahepatic portal vein obstruction, and transplant vascular occlusions, and examines radiologic interventions to address these conditions. Management strategies are divided into relieving the primary cause of PHTN at the level of portal obstruction and managing the secondary effects of PHTN. For each category, the discussion focuses on device selection, postprocedural care, imaging surveillance, and management of pediatric scenarios.