Transhepatic catheter-directed thrombolysis for portal vein thrombosis after partial splenic embolization in combination with balloon-occluded retrograde transvenous obliteration of splenorenal shunt.
A 66-year-old woman underwent partial splenic embolization (PSE) for hypersplenism with idiopathic portal hypertension (IPH). One week later, contrast-enhanced CT revealed extensive portal vein thrombosis (PVT) and dilated portosystemic shunts. The PVT was not dissolved by the intravenous administration of urokinase. The right portal vein was canulated via the percutaneous transhepatic route under ultrasonic guidance and a 4 Fr. straight catheter was advanced into the portal vein through the thrombus. Transhepatic catheter-directed thrombolysis was performed to dissolve the PVT and a splenorenal shunt was concurrently occluded to increase portal blood flow, using balloon-occluded retrograde transvenous obliteration (BRTO) technique. Subsequent contrast-enhanced CT showed good patency of the portal vein and thrombosed splenorenal shunt. Transhepatic catheter-directed thrombolysis combined with BRTO is feasible and effective for PVT with portosystemic shunts.
Nakai
Motoki
M
Department of Radiology, Hidaka General Hospital, Gobo Shi, Wakayama 644-8655, Japan. nakai@hidakagh.gobo.wakayama.jp
Sato
Morio
M
Sahara
Shinya
S
Kawai
Nobuyuki
N
Kimura
Masashi
M
Maeda
Yoshimasa
Y
Ibata
Yumiko
Y
Higashi
Katsuhiko
K
D000368:Aged; D002404:Catheterization / Q000379:methods*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D011169:Portal Vein / Q000000981:diagnostic imaging* / Q000473:pathology*; D013164:Splenorenal Shunt, Surgical; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000473:pathology*