Abstract
Although sequelae of chronic liver disease are the most common causes of altered pressure dynamics in the portal and splanchnic circulations, there are other mechanisms resulting in increased venous pressures with subsequent development of splenic and gastric varices. We report a case of a patient without portal hypertension, but with bleeding gastric varices with a presumed splenorenal shunt (SRS) on CT. Venography revealed flow reversal through the shunt (directed from the renal vein, into the splenic vein and out the portal vein; a renal-splent shunt (RSR)) and thus an anatomically similar but functionally distinct systemic to mesenteric variant. While being anatomically similar to the well-known SRS, the different flow dynamics necessitate a different approach for treatment and important considerations for the use of any liquid embolic.
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Saad WEA, Kitanosono T, Koizumi J. Balloon-occluded antegrade transvenous obliteration with or without balloon-occluded retrograde transvenous obliteration for the management of gastric varices: concept and technical applications. Tech Vasc Interv Radiol. 2012;15:203–25.
Sabri SS, Saad WEA. Anatomy and classification of gastrorenal and gastrocaval shunts. Semin Interv Radiol. 2011;28:296–302.
Park JK, Saab S, Kee ST, Busuttil RW, Kim HJ, Durazo F, et al. Balloon-occluded retrograde transvenous obliteration (BRTO) for treatment of gastric varices: review and meta-analysis. Dig Dis Sci. 2015;60:1543–53.
Colle I, Geerts AM, Van Steenkiste C, Van Vlierberghe H. Hemodynamic changes in splanchnic blood vessels in portal hypertension. Anat Rec Hoboken NJ. 2007;2008(291):699–713.
Ishikawa T, Sasaki R, Nishimura T, Matsuda T, Maeda M, Iwamoto T, et al. Liver stiffness measured by transient elastography as predictor of prognoses following portosystemic shunt occlusion. J Gastroenterol Hepatol. 2019;34:215–23.
Hirota S, Kobayashi K, Kako Y, Takaki H, Yamakado K. Balloon-occluded retrograde transvenous obliteration of varices: focusing on the portal hemodynamics and the recent techniques. Hepatol Int. 2018;12:102–11.
Kandpal H, Sharma R, Gamangatti S, Srivastava DN, Vashisht S. Imaging the inferior vena cava: a road less traveled. Radiogr Rev Publ Radiol Soc N Am Inc. 2008;28:669–89
Lee EW, Shahrouki P, Alanis L, Ding P, Kee ST. Management Options for Gastric Variceal Hemorrhage. JAMA Surg. 2019
Srinivasa RN, Majdalany BS, Chick JFB, Meadows JM, Fenlon JB, Brewerton C, et al. Single-session percutaneous endovascular mesocaval shunt creation and balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices. Ann Vasc Surg. 2018;46:371.e1–.e6.
Arabi M, Vellody R, Cwikiel WB, Gemmete JJ. Endovascular treatment of lower gastrointestinal bleeding from systemic-to-mesenteric venous collateral vessels caused by inferior vena cava occlusion: report of two cases. J Vasc Interv Radiol JVIR. 2011;22:1035–8.
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Supplemental Video: Initial diagnostic power injection venogram revealing high-grade distal IVC stenosis and renal shunt to splenic varices with subsequent hepatopetal flow from varices to the splenic vein and portal vein (AVI 5335 kb)
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Jamshidi, N., Kee, S.T. Transcatheter Embolization of Renal–Splenic Shunt to Treat Hematemesis. Cardiovasc Intervent Radiol 43, 1708–1711 (2020). https://doi.org/10.1007/s00270-020-02578-3
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DOI: https://doi.org/10.1007/s00270-020-02578-3