Fig. 2. A 64-year-old male with alcoholic cirrhosis, portal vein thrombosis and cavernous malformation of the gastric variceal bleeding. (A) Initial venogram following access through the right internal jugular vein and catheterization of the gastrorenal shunt shows filling of the collateral left inferior phrenic vein (dashed arrows) along with the gastric varices (GV) (arrow). (B) Left inferiorphrenic vein is embolized using a microcatheter and micro-Nester coils. (C) Spot image post embolization of the GV shows inflated balloon catheter along with pooling of the dense embolization material within the GV (arrowhead). (D) Follow-up upper gastrointestinal endoscopy 6 months after the procedure shows grade II lower esophageal varices (EV) (arrows), without evidence of bleeding. These EV are successfully banded. (E) Follow-up computed tomography scan of the abdomen 12 months post procedure shows persistent portal vein thrombosis (arrow) with cavernous malformation of the portal vein (dashed arrow). (F) Note persistent dense embolization material within the previous GV (arrow). Patient remains symptoms free on the follow-up for more than 3 years.
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