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Percutaneous Transsplenic Access to the Portal Vein for Management of Vascular Complication in Patients with Chronic Liver Disease

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Abstract

Purpose

To evaluate the safety and feasibility of percutaneous transsplenic access to the portal vein for management of vascular complication in patients with chronic liver diseases.

Methods

Between Sept 2009 and April 2011, percutaneous transsplenic access to the portal vein was attempted in nine patients with chronic liver disease. Splenic vein puncture was performed under ultrasonographic guidance with a Chiba needle, followed by introduction of a 4 to 9F sheath. Four patients with hematemesis or hematochezia underwent variceal embolization. Another two patients underwent portosystemic shunt embolization in order to improve portal venous blood flow. Portal vein recanalization was attempted in three patients with a transplanted liver. The percutaneous transsplenic access site was closed using coils and glue.

Results

Percutaneous transsplenic splenic vein catheterization was performed successfully in all patients. Gastric or jejunal varix embolization with glue and lipiodol mixture was performed successfully in four patients. In two patients with a massive portosystemic shunt, embolization of the shunting vessel with a vascular plug, microcoils, glue, and lipiodol mixture was achieved successfully. Portal vein recanalization was attempted in three patients with a transplanted liver; however, only one patient was treated successfully. Complete closure of the percutaneous transsplenic tract was achieved using coils and glue without bleeding complication in all patients.

Conclusion

Percutaneous transsplenic access to the portal vein can be an alternative route for portography and further endovascular management in patients for whom conventional approaches are difficult or impossible.

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Acknowledgments

This study was supported by a grant from the Korea Healthcare technology R&D projects, Ministry of Health, Welfare & Family Affairs, Republic of Korea (A100655).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Institute of Radiation Medicine, Clinical Research Institute, Seoul National University College of Medicine, Seoul National University Medical Research Center, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea

    Hee Ho Chu, Hyo-Cheol Kim, Hwan Jun Jae, Jin Wook Chung & Jae Hyung Park

  2. Department of Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea

    Nam-Joon Yi, Kwang-Woong Lee & Kyung-Suk Suh

Authors
  1. Hee Ho Chu
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  2. Hyo-Cheol Kim
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  3. Hwan Jun Jae
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  4. Nam-Joon Yi
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  5. Kwang-Woong Lee
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  6. Kyung-Suk Suh
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  7. Jin Wook Chung
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  8. Jae Hyung Park
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Correspondence to Hyo-Cheol Kim.

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Chu, H.H., Kim, HC., Jae, H.J. et al. Percutaneous Transsplenic Access to the Portal Vein for Management of Vascular Complication in Patients with Chronic Liver Disease. Cardiovasc Intervent Radiol 35, 1388–1395 (2012). https://doi.org/10.1007/s00270-011-0311-y

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  • DOI: https://doi.org/10.1007/s00270-011-0311-y

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