Percutaneous retroperitoneal splenorenal shunt creation after failed PVR-TIPS attempt

Gastric and esophageal variceal bleeding causes significant morbidity and mortality. TIPS creation is one of many methods to treat and reduce the risk of variceal hemorrhage. In such cases where TIPS cannot be created, percutaneous retroperitoneal splenorenal shunt (PRESS) creation serves as one alternative to decompress the portal venous system. This case highlights a case of PRESS creation from splenic vein to left adrenal vein as a method to decompress the splanchnic venous system in cases of chronic portal vein thrombosis with cavernous transformation when PVR-TIPS fails, with subsequent 6 month follow-up.