Meso-Rex shunt: Thrombus detected with TTFM and HFUS


This case demonstrates how Transit Time Flow Measurement (TTFM) and High-Frequency Ultrasound (HFUS) were instrumental in avoiding a catastrophic incident. A thrombus in the saphenous vein graft (SVG) was detected during surgery.

Meso-Rex shunt is a surgical procedure that restores physiological portal venous blood flow to the liver by using a graft to connect the superior mesenteric vein and the left portal vein within the Rex recess.

Intraoperative completion control with TTFM and HFUS

During the procedure, the SVG was accidentally sewn in the wrong direction. When performing TTFM on the graft it showed no flow and a very high PI as seen in image 1. 

The surgeon used Doppler, which revealed some sound but was inconclusive. Palpation of the graft indicated that it was pulsative. The surgeon further assessed the graft by using HFUS which revealed a thrombus that occluded the SVG as seen in image 2.

The SVG was exchanged with part of the internal jugular vein. Post revision, TTFM showed an increased flow and a much lower PI, which was acceptable as seen in image 3.

This case confirms that TTFM and HFUS played a critical role in avoiding a severe postoperative incident that could have been catastrophic for both patient and surgeon.

Technology Used

Medistim MiraQ Vascular System with TTFM and HFUS probes.


Case Example by VAMC, Washington, DC, USA

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