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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: Thrombus detected with TTFM and HFUS
Case story
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 mage 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 (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 (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.
Case attachments
Click images below to view.
TTFM showing no flow and high PI
HFUS revealing thrombus in SVG
TTFM confirming acceptable flow and PI after revision
Reference
Case example by VAMC, Washington, DC, USA.
Technology used
Medistim MiraQ™ Vascular System with Vascular TTFM Probes (PV series) and L15 High-Frequency Imaging Probe.
