Use of a recanalized umbilical vein to embolize bleeding varices: A case report

This case report details the successful management of life-threatening gastric variceal bleeding in a female in her 60s with decompensated liver cirrhosis. The patient presented with hematemesis and hemorrhagic shock. After initial resuscitation, an esophagogastroduodenoscopy identified large gastric varices with signs of recent bleeding. A conventional transfemoral endovascular attempt to embolize the varix failed due to tortuous venous anatomy. Given the failure, an alternative approach was utilized by accessing a patent, recanalized umbilical vein. Under ultrasound guidance, this percutaneous transumbilical route provided direct access to the portal venous system. A catheter was successfully navigated to the coronary vein feeding the gastric varix, and embolization was performed using a liquid embolic system, achieving complete hemostasis. This case highlights the transumbilical approach as a safe and effective alternative for the endovascular treatment of bleeding gastric varices when traditional access is not feasible.