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Case Reports
. 2006 Aug 21;12(31):5071-4.
doi: 10.3748/wjg.v12.i31.5071.

Transhepatic catheter-directed thrombolysis for portal vein thrombosis after partial splenic embolization in combination with balloon-occluded retrograde transvenous obliteration of splenorenal shunt

Motoki Nakai  1 , Morio Sato, Shinya Sahara, Nobuyuki Kawai, Masashi Kimura, Yoshimasa Maeda, Yumiko Ibata, Katsuhiko Higashi
Affiliations
Case Reports

Transhepatic catheter-directed thrombolysis for portal vein thrombosis after partial splenic embolization in combination with balloon-occluded retrograde transvenous obliteration of splenorenal shunt

Motoki Nakai et al. World J Gastroenterol. .

Abstract

A 66-year-old woman underwent partial splenic embolization (PSE) for hypersplenism with idiopathic portal hypertension (IPH). One week later, contrast-enhanced CT revealed extensive portal vein thrombosis (PVT) and dilated portosystemic shunts. The PVT was not dissolved by the intravenous administration of urokinase. The right portal vein was canulated via the percutaneous transhepatic route under ultrasonic guidance and a 4 Fr. straight catheter was advanced into the portal vein through the thrombus. Transhepatic catheter-directed thrombolysis was performed to dissolve the PVT and a splenorenal shunt was concurrently occluded to increase portal blood flow, using balloon-occluded retrograde transvenous obliteration (BRTO) technique. Subsequent contrast-enhanced CT showed good patency of the portal vein and thrombosed splenorenal shunt. Transhepatic catheter-directed thrombolysis combined with BRTO is feasible and effective for PVT with portosystemic shunts.

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Figures

Figure 1
Figure 1
Abdominal CT one week after PSE. A: Plain CT showing high density lesions in the main portal vein and the 1st right branch (narrow arrow); B: Contrast-enhanced CT revealing no enhancement of portal vein indicating portal thrombosis (thick arrow) and portosystemic shunts (arrow head). Splenic infarction after PSE was also visualized.
Figure 2
Figure 2
No visualization of main portal vein due to extensive thrombosis (narrow arrow) and visualization of portosystemic shunts such as dilated left gastric vein and splenorenal shunt draining into left renal vein (thick arrow) on percutaneous transhepatic portography.
Figure 3
Figure 3
Percutaneous transhepatic portography after catheter-directed thrombolysis. A: Dissolution of the thrombus in portal vein (narrow arrow); B: Hepatofugal flow into dilated portosystemic shunts (thick arrow: left renal vein).
Figure 4
Figure 4
PTP after BRTO. BRTO was attempted to occlude splenorenal shunt in order to increase portal blood flow. A 7Fr balloon catheter (arrow) was advanced into the outflow pathway of the splenorenal shunt. A total of 10 mL of 5% ethanolamine oleate iopamidol (EOI) was injected and remained stagnant for a day during balloon occlusion.
Figure 5
Figure 5
Contrast-enhanced CT 1 wk after catheter-directed thrombolysis and BRTO. A: Good patency of the portal vein (narrow arrow); B: Thrombosed splenorenal shunt (thick arrow).
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