title: Portal vein recanalization and embolization of the transsplenic puncture tract using an Amplatzer® vascular plug: a case report.
abstract: BACKGROUND
  A transsplenic access for the catheterization of the portal venous system to treat a portal vein thrombosis and/or stenosis entails the risk of intra-abdominal or intrasplenic bleeding complications and has to be seen as an approach of last resort. This is one of few reported cases in the literature where a transsplenic puncture tract was successfully embolized using an Amplatzer® vascular plug 4 (8 mm; St. Jude Medical).
  
  
  METHODS
  This is the case report of a 58 years old Caucasian male patient who had received right sided extended hemihepatectomy with partial resection of the portal vein due to hilar cholangiocarcinoma three years ago. The patient suffered from portal hypertension with difficult controllable bleeding of esophageal varices due to chronically progressive thrombosis of the portal vein caused by chronic anastomosis stenosis of the reconstructed left portal vein branch (confirmed in a Magnetic Resonance Imaging (MRI) examination 6 months after the portal vein reconstruction). A transsplenic access (6 French) was chosen to allow recanalization of the portal vein, stent-angioplasty of the anastomosis and coiling of the gastric varices. The transsplenic tract was successfully embolized with an Amplatzer® Vascular Plug 4 and gelfoam pledgets.
  
  
  CONCLUSIONS
  Amplatzer® Vascular plugs in combination with gelatin sponges can be used to efficiently and precisely seal transsplenic puncture sites.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Berlin, Tuebingen, Germany. Ulrich.grosse@med.uni-tuebingen.de.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Grosse
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Berlin, Tuebingen, Germany. Klaus.brechtel@med.uni-tuebingen.de.
authors.forename: Klaus
authors.initials: K
authors.lastname: Brechtel
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Berlin, Tuebingen, Germany. Dominik.ketelsen@med.uni-tuebingen.de.
authors.forename: Dominik
authors.initials: D
authors.lastname: Ketelsen
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Berlin, Tuebingen, Germany. Roland.syha@med.uni-tuebingen.de.
authors.forename: Roland
authors.initials: R
authors.lastname: Syha
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Berlin, Tuebingen, Germany. Gerd.groezinger@med.uni-tuebingen.de.
authors.forename: Gerd
authors.initials: G
authors.lastname: Grözinger
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Berlin, Tuebingen, Germany. Fabian.springer@med.uni-tuebingen.de.
authors.forename: Fabian
authors.initials: F
authors.lastname: Springer
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Berlin, Tuebingen, Germany. Christoph.thomas@med.uni-tuebingen.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Thomas
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D003287:Contrast Media; D004621:Embolization, Therapeutic; D006801:Humans; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology*; D011172:Portography; D049268:Positron-Emission Tomography; D011677:Punctures / Q000295:instrumentation*; D011860:Radiography, Abdominal; D013154:Spleen / Q000000981:diagnostic imaging / Q000473:pathology*; D015607:Stents; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D003287:Contrast Media