Procedures

Using innovative endoscopic, surgical, and radiologic procedures (such as X-rays and ultrasound), we are able to treat abnormally blocked or narrowed blood vessels, and thus prevent the damage that they cause. These procedures may eliminate the need for liver transplantation in many patients. 

Balloon retrograde transvenous obliteration of gastric varices (BRTO). This is a procedure that involves shutting off or obstructing the portosystemic shunt using a balloon. The shunt is an abnormal vessel in the body that allows blood to go around, or bypass, the liver. This is a dangerous condition because if the blood bypasses the liver, it is unable to perform one of its main functions which is to cleanse the blood.

Cyanoacrylate endoscopic injection of gastric varices. In this procedure, our physicians inject medication into bleeding varices in the stomach in order to stop the bleeding, when standard endoscopic treatment is ineffectual. This procedure is only offered at a handful of medical centers in the United States.

Rex shunt. This is a surgical procedure used to redirect blood back into the liver around an area of blockage. This is the treatment of choice for children with extra-hepatic portal vein thrombosis.

Long Transjugular Intrahepatic Portosystemic Shunt (TIPS). This procedure can be preferred in the setting of extensive portomesenteric thrombosis to re-establish blood flow to the liver.  Our interventional radiology team is nationally known as one of the most experienced teams in performing these procedures.

Transvenous Mesocaval Shunting. Such shunt procedures were previously only performed by complicated, open surgeries but now can be performed by our interventional radiology team.

Sugiura Procedure.  Rarely the lower part of the esophagus and upper part of the stomach need to be surgically resected in patients with refractory variceal bleeding in the setting of portomesenteric thrombosis.  Mount Sinai surgeons have longstanding expertise in the performance of this surgery.

Intestinal Transplantation.  Patients who have a clotting disorder may lose their intestine due to ischemia and be left with short-gut syndrome and intestinal failure.  In this setting, intestinal transplantation may prevent the development of fatal complications related to parenteral nutrition.  However, intestinal rehabilitation and use of growth factors by our experienced team of physicians and nutritionists in some instances can mitigate the need for transplantation.

Multivisceral Transplantation. If all measures for treating portomesenteric thrombosis are unsuccessful, multivisceral transplantation, including liver, small intestine, pancreas, and colon may be a necessary, life-saving option.  The Mount Sinai Intestinal Transplant program is one of the longest standing in the country with a team of surgeons and clinicians who are knowledgeable, experienced, and most capable of performing these complex surgeries.