title: Percutaneous transsplenic portal vein catheterization: technical procedures, safety, and clinical applications.
abstract: OBJECTIVE
  To evaluate the safety and feasibility of percutaneous transsplenic portal vein catheterization (PTSPC) by retrospective review of its use in patients with portal vein (PV) occlusion.
  
  
  METHODS
  From July 2004 to December 2010, 46 patients with a history of uncontrolled gastroesophageal variceal bleeding secondary to portal hypertension underwent endovascular PV interventions via a percutaneous transsplenic approach. All patients had occlusion of the main PV or central intrahepatic PV branches, which prevented the performance of a transhepatic approach. A vein within the splenic parenchyma was punctured under fluoroscopic guidance by referencing preoperative computed tomography images. PTSPC-related complications and clinical applications were analyzed.
  
  
  RESULTS
  PTSPC was successfully performed in 44 of 46 patients (96%); two failures were caused by inaccessible small intrasplenic veins. PTSPC-related major bleeding complications occurred in three patients (6.5%), including large intraperitoneal hemorrhage in one patient and large splenic subcapsular hemorrhage in two patients. Two of the three patients developed hypotension, and one developed severe anemia. All three of the patients required blood transfusions. PTSPC-related minor bleeding complications occurred in six patients (13%) as a result of a small splenic subcapsular hemorrhage. In addition, three patients exhibited mild left pleural effusion, which subsided spontaneously 1 week later. All 44 patients successfully treated via PTSPC received gastroesophageal variceal embolization. Eight patients received PV stents, five for treatment of PV occlusion and three during transjugular intrahepatic portosystemic shunt placement.
  
  
  CONCLUSIONS
  PTSPC is a safe and effective access for endovascular PV interventions in patients without a transhepatic window.
authors.affiliation: Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road Guangzhou, Guangdong Province, 510630, China.
authors.forename: Kangshun
authors.initials: K
authors.lastname: Zhu
authors.forename: Xiaochun
authors.initials: X
authors.lastname: Meng
authors.forename: Bin
authors.initials: B
authors.lastname: Zhou
authors.forename: Jiesheng
authors.initials: J
authors.lastname: Qian
authors.forename: Wensou
authors.initials: W
authors.lastname: Huang
authors.forename: Meihai
authors.initials: M
authors.lastname: Deng
authors.forename: Hong
authors.initials: H
authors.lastname: Shan
mesh_terms: D000328:Adult; D002406:Catheterization, Peripheral / Q000009:adverse effects; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D011169:Portal Vein / Q000000981:diagnostic imaging; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D015641:Radiography, Interventional; D012189:Retrospective Studies; D013162:Splenic Vein / Q000000981:diagnostic imaging; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome