Fig. 4. A 47-year-old man with underlying cirrhosis presenting with upper gastric variceal bleeding as seen on endoscopy. The patient underwent transjugular intrahepatic portosystemic shunts (TIPS) revision 4 months and 13 months after TIPS placement. (A) Initial portal venogram demonstrates patent TIPS stent with some collateral veins (arrow) filling varices. (B) Selective venogram from posterior gastric (arrow) vein shows retrograde filling of the gastric varices (GV). Balloon occlusion venogram of the gastrorenal shunt shows retrograde filling of the GV along with a draining collateral vein. (C) The left inferior phrenic vein (arrow) is embolized using microcoils and the GV (dashed arrow) are then embolized using sodium tetradecyl sulfate (Sotradecol; AngioDynamics, Queensbury, NY, USA) mixed with Lipiodol (Ethiodol; Savage Laboratories, Melville, NY, USA). (D) Follow-up magnetic resonance imaging 3 1/2 years later shows complete obliteration of GV.
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