Open AccessTranscatheter Embolization of Renal–Splenic Shunt to Treat Hematemesis
Author(s) -
Neema Jamshidi,
Stephen T. Kee
Publication year - 2020
Publication title -
cardiovascular radiology/cardiovascular and interventional radiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.767
H-Index - 83
eISSN - 0342-7196
pISSN - 0174-1551
DOI - 10.1007/s00270-020-02578-3
Subject(s) - medicine , portal hypertension , splenic vein , shunt (medical) , portal venous pressure , radiology , splanchnic , gastric varices , embolization , portosystemic shunt , varices , venography , mesenteric vein , splanchnic circulation , sclerotherapy , superior mesenteric vein , blood flow , surgery , cirrhosis , portal vein , thrombosis
Although sequelae of chronic liver disease are the most common causes of altered pressure dynamics in the portal and splanchnic circulations, there are other mechanisms resulting in increased venous pressures with subsequent development of splenic and gastric varices. We report a case of a patient without portal hypertension, but with bleeding gastric varices with a presumed splenorenal shunt (SRS) on CT. Venography revealed flow reversal through the shunt (directed from the renal vein, into the splenic vein and out the portal vein; a renal-splent shunt (RSR)) and thus an anatomically similar but functionally distinct systemic to mesenteric variant. While being anatomically similar to the well-known SRS, the different flow dynamics necessitate a different approach for treatment and important considerations for the use of any liquid embolic.