title: Percutaneous transhepatic and transsplenic portal vein access: embolization of the puncture tract using amplatzer vascular plugs.
abstract: OBJECTIVE
  To report on first results of the embolization of transhepatic and transsplenic puncture tracts using an Amplatzer Vascular Plug (AVP) after percutaneous portal vein intervention.
  
  
  METHODS
  Embolization of transhepatic and transsplenic puncture tracts with AVP was attempted in 5 patients (3 females; age range: 3 - 71 years). Portal vein access was gained by a transhepatic (n = 4) or transsplenic (n = 1) approach, and stenosis (n = 2) or thrombosis (n = 3) of the portal vein was successfully treated by percutaneous stenting or thrombus aspiration and thrombolysis using 6 to 10 French sheaths. Due to the relatively large bore and/or short transparenchymal puncture tracts, it was considered favorable to use AVPs as an embolic agent. The medical records, the radiological reports and images of these 5 patients were retrospectively evaluated.
  
  
  RESULTS
  In three cases one AVP II (diameter, 4 mm), in one case one AVP IV (diameter, 4 mm) and in one case two AVPs II (diameter, 8 and 6 mm) were used for embolization of the puncture tract. In all five cases embolization was technically successful. There was no bleeding from the puncture tract. During a median follow-up of 14 months (range, 21 days to 21 months), one patient developed a focal liver abscess adjacent to the AVP which was successfully treated by antimicrobial and drainage therapy. There were no further embolization-related complications.
  
  
  CONCLUSIONS
  AVPs are suited to embolize large bore and/or short transhepatic and transsplenic puncture tracts effectively, safely, and precisely. Caution is required in patients with an increased risk for infectious complications.
  
  
  CONCLUSIONS
  • Embolization of transhepatic and transsplenic puncture tracts with AVPs is feasible• Large and/or short puncture tracts can be effectively embolized with AVPs• The risk of infectious complications has to be considered Citation Format: • Dollinger M, Goessmann H, Mueller-Wille R et al. Percutaneous Transhepatic and Transsplenic Portal Vein Access: Embolization of the Puncture Tract Using Amplatzer Vascular Plugs. Fortschr Röntgenstr 2014; 186: 142 - 150.
authors.forename: M
authors.initials: M
authors.lastname: Dollinger
authors.forename: H
authors.initials: H
authors.lastname: Goessmann
authors.forename: R
authors.initials: R
authors.lastname: Mueller-Wille
authors.forename: W A
authors.initials: WA
authors.lastname: Wohlgemuth
authors.forename: C
authors.initials: C
authors.lastname: Stroszczynski
authors.forename: P
authors.initials: P
authors.lastname: Heiss
mesh_terms: D000293:Adolescent; D000328:Adult; D002406:Catheterization, Peripheral / Q000295:instrumentation* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000293:injuries*; D011677:Punctures / Q000009:adverse effects*; D011859:Radiography; D055989:Septal Occluder Device; D013162:Splenic Vein / Q000000981:diagnostic imaging / Q000293:injuries*; D016896:Treatment Outcome; D055815:Young Adult