PMC3972861_01
(a) Axial contrast-enhanced CT demonstrates diminutive portal vein (red arrow) and minimal perihepatic ascites (white arrow). (b) Axial CT demonstrates enlarged spleen with multiple perisplenic collateral vessels. A large splenorenal shunt (red arrow) is seen arising from a dilated left renal vein (blue arrow).
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Contrast-enhanced computed tomography (CT) scan one week prior to clinic presentation demonstrated cirrhosis, minimal ascites, and a diminutive but patent portal vein (Figure 1(a)). There was marked splenomegaly with extensive collateral vessels medial to the spleen with a spontaneous splenorenal shunt (Figure 1(b)).
Venograms following selection of the left gonadal vein after Amplatzer plug deployment (arrow).
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(a) Venogram after deployment of Amplatzer vascular plug (arrow) within splenorenal shunt. (b) Final image following placement of additional coils between initially placed coils and Amplatzer vascular plug.
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Amplatzer vascular plug was deployed through the 6-Fr Destination sheath (Figure 3(a)). After advancing a Renegade STC microcatheter (Boston Scientific, Natick, Massachusetts) into the proximal part of the shunt, the splenorenal shunt was embolized with 0.035 inch Interlock microcoils (Boston Scientific, Natick, Massachusetts) and gelfoam slurry (Figure 3(b)). No immediate complications were observed.
(a) Contrast-enhanced CT on postprocedure day 2 demonstrates Amplatzer vascular plug (white arrow) and coils (red arrow) within a splenorenal shunt. (b) White arrows demonstrate absence of flow distally in embolized splenorenal shunt.
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A contrast-enhanced CT performed 2 days later demonstrated interval complete absence of perfusion of the gonadal and splenorenal shunts (Figure 4).
Catheter angiogram following coil and Gelfoam placement into the splenocaval shunt demonstrates draining collateral vessel (arrow) from the splenocaval shunt into the left renal vein, which was subsequently embolized with coils as well.
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Repeat angiography was subsequently performed; although shunts originally closed with PARTO were still occluded, a persistent left splenocaval shunt was seen again, as well as collateral vessel extending from the shunt to the left renal vein (Figure 5).