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CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2022; 06(03): 220-222
DOI: 10.1055/s-0041-1739044
Short Communication

Management of Bleed from Percutaneous Portal Puncture Site (post-BRTO) by Trans-jugular-Trans-Hepatic Embolization

Raghav Seth 
1   Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
,
Arun Gupta
1   Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
,
Ajit Yadav 
1   Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
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Abstract

We report the case of an elderly male, who was a known case of chronic liver parenchymal disease. He presented with a history of melena for 2 weeks and upper-GI endoscopy revealed fundal varices. He was planned for BRTO. Along with BRTO, a percutaneous trans-hepatic puncture of a branch of the right portal vein was also performed for proper embolization of the varices. The trans-hepatic puncture-tract was embolized after the procedure. However, after 24 hours of the procedure, the patient developed hypotension and abdominal distension due to hemorrhage from the portal puncture site. Portal-venography was performed via the trans-jugular-trans-hepatic route to confirm the source of hemorrhage and embolization of the culprit portal venous branch was performed via the same route. The patient was stable after the procedure.

Various interventional procedures via the trans-jugular route have been routinely described in the literature, including trans-jugular liver biopsies, placement of TIPSS shunts and endovascular interventions for haemodialysis. However, the literature on trans-jugular embolization of portal vein is scarce. This case describes the unexpected clinical situation, in the form of bleeding from the portal puncture site, despite embolization of the trans-hepatic tract after BRTO. Finally, a creative solution was thought of and trans-jugular embolization of the portal vein was performed, which succeeded in terminating the ongoing bleeding from the portal vein.

Keywords

BRTO - portal vein embolization


Publication History

Article published online:
12 November 2021

© 2021. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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