Type:
Educational Exhibit
Keywords:
Education and training, Venous access, Catheters, Ultrasound, Fluoroscopy, Vascular, Spleen, Interventional vascular
Authors:
G. Kumar1, M. kolber2, H. shah2, M. Still3, D. Lamus2, S. Kalva4, M. reddick2; 1Plano/US, 2Dallas/US, 3Dallas, TX/US, 4BOSTON, MA/US
DOI:
10.26044/ecr2019/C-3726
Background
Conventional methods of portal venous access including transjugular-intrahepatic and percutaneous transhepatic approaches have been well studied and verified for portal access in the creation of TIPS and other mesenteric venous interventions.
However, certain clinical scenarios such as portal vein thrombosis (PVT) and interposing tumor pose significant anatomic challenges resulting in high technical failure rate.
Trans-splenic portal venous access has been used as an alternative/ rescue method for mesenteric venous access,
portal venous (PV) catheterization as well as PV recanalization.
Historical risks of trans-splenic access have largely been mitigated by real-time ultrasound guidance and smaller sheath sizes.
The trans-splenic approach also provides additional benefits in particular clinical scenarios such as chronic liver failure complicated by variceal hemorrhage,
PVT,
and coexisting ascites.