Transsplenic Portal System Catheterization: Review of Current Indications and Techniques.

Document Type

Article

Abstract

Multiple diseases of the portal system require effective portal vein access for endovascular management. While percutaneous transhepatic and transjugular approaches remain the standard methods of portal vein access, transsplenic access (TSA) has gained recognition as an effective and safe technique to access the portal system in patients with contraindications to traditional approaches. Recently, the utility of percutaneous TSA has grown, with described treatments including recanalization of chronic portal vein occlusion, placement of stents for portal vein stenosis, portal vein embolization of the liver, embolization of gastric varices, placement of complicated transjugular intrahepatic portosystemic shunts, and interventions after liver transplant. The authors provide a review of percutaneous TSA, including indications, a summary of related portal vein diseases, and the different techniques used for access and closure. In addition, an imaging-based review of technical considerations of TSA interventions is presented, with a review of potential procedural complications. With technical success rates that mirror or rival the standard methods and reported low rates of major complications, TSA can be a safe and effective option in clinical scenarios where traditional approaches are not feasible.

Medical Subject Headings

Catheterization; Embolization, Therapeutic; Esophageal and Gastric Varices; Humans; Liver Transplantation; Portal Vein; Portasystemic Shunt, Transjugular Intrahepatic; Treatment Outcome

Publication Date

1-1-2022

Publication Title

Radiographics : a review publication of the Radiological Society of North America, Inc

ISSN

1527-1323

Volume

42

Issue

5

First Page

1562

Last Page

1576

PubMed ID

35984753

Digital Object Identifier (DOI)

10.1148/rg.220042

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