title: Percutaneous transsplenic access to the portal vein for management of vascular complication in patients with chronic liver disease.
abstract: OBJECTIVE
  To evaluate the safety and feasibility of percutaneous transsplenic access to the portal vein for management of vascular complication in patients with chronic liver diseases.
  
  
  METHODS
  Between Sept 2009 and April 2011, percutaneous transsplenic access to the portal vein was attempted in nine patients with chronic liver disease. Splenic vein puncture was performed under ultrasonographic guidance with a Chiba needle, followed by introduction of a 4 to 9F sheath. Four patients with hematemesis or hematochezia underwent variceal embolization. Another two patients underwent portosystemic shunt embolization in order to improve portal venous blood flow. Portal vein recanalization was attempted in three patients with a transplanted liver. The percutaneous transsplenic access site was closed using coils and glue.
  
  
  RESULTS
  Percutaneous transsplenic splenic vein catheterization was performed successfully in all patients. Gastric or jejunal varix embolization with glue and lipiodol mixture was performed successfully in four patients. In two patients with a massive portosystemic shunt, embolization of the shunting vessel with a vascular plug, microcoils, glue, and lipiodol mixture was achieved successfully. Portal vein recanalization was attempted in three patients with a transplanted liver; however, only one patient was treated successfully. Complete closure of the percutaneous transsplenic tract was achieved using coils and glue without bleeding complication in all patients.
  
  
  CONCLUSIONS
  Percutaneous transsplenic access to the portal vein can be an alternative route for portography and further endovascular management in patients for whom conventional approaches are difficult or impossible.
authors.affiliation: Department of Radiology, Institute of Radiation Medicine, Clinical Research Institute, Seoul National University College of Medicine, Seoul National University Medical Research Center, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
authors.forename: Hee Ho
authors.initials: HH
authors.lastname: Chu
authors.forename: Hyo-Cheol
authors.initials: HC
authors.lastname: Kim
authors.forename: Hwan Jun
authors.initials: HJ
authors.lastname: Jae
authors.forename: Nam-Joon
authors.initials: NJ
authors.lastname: Yi
authors.forename: Kwang-Woong
authors.initials: KW
authors.lastname: Lee
authors.forename: Kyung-Suk
authors.initials: KS
authors.lastname: Suh
authors.forename: Jin Wook
authors.initials: JW
authors.lastname: Chung
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003287:Contrast Media; D004621:Embolization, Therapeutic; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008107:Liver Diseases / Q000150:complications*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology*; D011170:Portasystemic Shunt, Surgical; D011172:Portography; D011677:Punctures; D015641:Radiography, Interventional; D013154:Spleen / Q000098:blood supply / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*
chemical_list: D003287:Contrast Media