@TWilsonMD I could explain, but I doubt you’d understand.

@dryadavtaruna We thought along similar lines @dryadavtaruna since this particular area of liver is prone to demonstrate pseudolesions and pseudotumors secondary to ‘third inflow’👇🏻. Biopsy conclusively ruled out malignancy and described it as nodular hyperplasia.

@ManavendraUpad1 @CasesCookyJar @cookyscan1 @RadioGraphics Thank you for the kind words😊🙏🏻

@CasesCookyJar @cookyscan1 @RadioGraphics #CookyBites #182

@ChengaziMD Don’t know if it will completely occlude the flow since these shunts often have small feeders from short and posterior gastric veins. Could definitely give it a try in the next case.

@karananandpara Yes Karan. But I have often seen new feeders open up from short and posterior gastric once you the block the coronary since it is very difficult to completely fill these shunts with liquid embolics without risking non target embolisation. And coils will only occlude the afferent.

@NoLimitIR @ChengaziMD @SanjayGovil8 @Sanchit30497977 @AASLDtweets @giri_gutnliver @doctorboletoh @keithppereira @DrArunKValsan @KailashKolhe @DrKaloo @SudheerPargewar Quite true. Problem in our resource constrained setting is that we can’t afford to use multiple coils to block these shunts in every patient. So, we pick and choose. Wonder if there is a better way to know which shunts are going to be an issue in the future for the patient.

@NoLimitIR @ChengaziMD @SanjayGovil8 @Sanchit30497977 @AASLDtweets @giri_gutnliver @doctorboletoh @keithppereira @DrArunKValsan @KailashKolhe @DrKaloo @SudheerPargewar So we usually don’t go too aggressive on coronary shunts. But i guess the sheer size of the shunt in the case discussed previously warranted a complete embolisation. Wonder if there are any other pointers🤔

@AtoosaRabiee @keithppereira @SanjayGovil8 @Sanchit30497977 @AASLDtweets @giri_gutnliver @doctorboletoh @DrArunKValsan @KailashKolhe @DrKaloo @SudheerPargewar @ebtapper LDLT. Optimal GRWR. No clinical evidence of graft dysfunction. Post banding, the patient settled and was discharged. We decided to wait it out. How soon would you expect these varices to involute post LT? Any recommendation for surveillance scopy in prior bleeders after LT?

@adityajnanavati @SanjayGovil8 @Sanchit30497977 @AASLDtweets @giri_gutnliver @doctorboletoh @keithppereira @DrArunKValsan @KailashKolhe @DrKaloo @SudheerPargewar Good to know. Thank you Dr Aditya.

@ChengaziMD @SanjayGovil8 @Sanchit30497977 @AASLDtweets @giri_gutnliver @doctorboletoh @keithppereira @DrArunKValsan @KailashKolhe @DrKaloo @SudheerPargewar If you notice carefully, some flow was still present in the shunt post TIPS. Perhaps i should have been more aggressive in blocking it.

@adityajnanavati @SanjayGovil8 @Sanchit30497977 @AASLDtweets @giri_gutnliver @doctorboletoh @keithppereira @DrArunKValsan @KailashKolhe @DrKaloo @SudheerPargewar Ok. How easy or difficult is it to ligate these coronary vein shunts (compared to lienorenal shunts) during LT?

@adityajnanavati @SanjayGovil8 @Sanchit30497977 @AASLDtweets @giri_gutnliver @doctorboletoh @keithppereira @DrArunKValsan @KailashKolhe @DrKaloo @SudheerPargewar Interesting thought. Have you ever come across such a situation (post transplant variceal bleed) in the presence of normal graft function Dr Aditya?

@DrKaloo @ebtapper @keithppereira @SanjayGovil8 @Sanchit30497977 @AASLDtweets @giri_gutnliver @doctorboletoh @DrArunKValsan @KailashKolhe @SudheerPargewar @AtoosaRabiee Thank you Shahnawaz. I noticed that 3/4th of patients in your cohort underwent shunt ligation during transplant. Has the practice changed now? How would you decide which shunts to ligate during LT? Have u ever embolised them prior to transplant?

@ebtapper @keithppereira @SanjayGovil8 @Sanchit30497977 @AASLDtweets @giri_gutnliver @doctorboletoh @DrArunKValsan @KailashKolhe @DrKaloo @SudheerPargewar @AtoosaRabiee Thank you for the comment sir. We also thought the same. But except for the bleed, there was nothing out of the ordinary in the post operative course of the patient. He got discharged 2 days back. How do you manage large portosystemic shunts in the peri-transplant period?