Related Experiment Videos
Percutaneous transsplenic balloon dilatation for stenotic distal splenorenal shunt
Insights
A minimally invasive procedure successfully treated stenosis in a splenorenal shunt, relieving esophageal varices bleeding in a cirrhotic patient. Direct splenic vein puncture and balloon angioplasty (PTA) proved effective when initial attempts failed.
Area of Science:
- Interventional Radiology
- Hepatology
- Vascular Surgery
Background:
- Distal splenorenal shunt (DSRS) is used to manage bleeding esophageal varices in cirrhotic patients.
- Stenosis of the DSRS can lead to recurrent variceal bleeding.
- Percutaneous transluminal angioplasty (PTA) is a potential treatment for DSRS stenosis.
Observation:
- A 27-year-old male with liver cirrhosis presented with DSRS stenosis and esophageal varices.
- Initial PTA via right femoral vein catheterization was unsuccessful.
- Direct sonographically guided splenic vein puncture was performed for balloon dilatation of the stenotic anastomosis.
Findings:
- Successful balloon dilatation of the stenotic DSRS anastomosis was achieved.
- Splenic vein pressure decreased from 35 to 29 cm H2O post-PTA.
- Follow-up barium esophagogram and esophagoscopy demonstrated significant regression of esophageal varices.
Implications:
- Direct sonographically guided splenic vein puncture is a viable alternative for DSRS stenosis treatment when conventional approaches fail.
- This technique offers effective management of recurrent variceal bleeding.
- It highlights the importance of tailored interventional strategies in complex vascular cases.
Abstract:
A 27 year old cirrhotic male underwent stenosis of the distal splenorenal shunt to treat bleeding of esophageal varices. Percutaneous transluminal angioplasty was performed first by catheterization of the right femoral vein, but without success. Therefore, a direct puncture of the splenic vein through the spleen was made, under sonographic guidance, followed by balloon dilatation of the stenotic anastomosis. The pressure of the splenic vein before and after PTA was 35 and 29 cm H2O, respectively. Both the follow-up barium esophagogram and esophagoscopy showed marked regression of the esophageal varices.