Transsplenic portal vein reconstruction-transjugular intrahepatic portosystemic shunt in a patient with portal and splenic vein thrombosis.
Portal vein thrombosis (PVT) is a potential complication of cirrhosis and can worsen outcomes after liver transplant (LT). Portal vein reconstruction-transjugular intrahepatic portosystemic shunt (PVR-TIPS) can restore flow through the portal vein (PV) and facilitate LT by avoiding complex vascular conduits. We present a case of transsplenic PVR-TIPS in the setting of complete PVT and splenic vein (SV) thrombosis. The patient had a 3-year history of PVT complicated by abdominal pain, ascites, and paraesophageal varices. A SV tributary provided access to the main SV and was punctured percutaneously under ultrasound scan guidance. PV access, PV and SV venoplasty, and TIPS placement were successfully performed without complex techniques. The patient underwent LT with successful end-to-end anastomosis of the PVs. Our case suggests transsplenic PVR-TIPS to be a safe and effective alternative to conventional PVR-TIPS in patients with PVT and SV thrombosis.
Department of Vascular Interventional Radiology, University of Miami Miller School of Medicine, 1611 NW 12th Ave, Miami, FL 33136-1005, USA.
Jason T
JT
Salsamendi
Department of Vascular Interventional Radiology, University of Miami Miller School of Medicine, 1611 NW 12th Ave, Miami, FL 33136-1005, USA.
Francisco J
FJ
Gortes
Department of Vascular Interventional Radiology, University of Miami Miller School of Medicine, 1611 NW 12th Ave, Miami, FL 33136-1005, USA.
Michelle
M
Shnayder
Department of Vascular Interventional Radiology, University of Miami Miller School of Medicine, 1611 NW 12th Ave, Miami, FL 33136-1005, USA.
Mehul H
MH
Doshi
Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Ave, Miami, FL 33136, USA.
Ji
J
Fan
Department of Vascular Interventional Radiology, University of Miami Miller School of Medicine, 1611 NW 12th Ave, Miami, FL 33136-1005, USA.
Govindarajan
G
Narayanan
Portal vein reconstruction; TIPS; Thrombosis