Fig. 5. A 63-year-old woman with underlying cirrhosis presenting with acute gastric variceal bleeding. (A) Coronal magnetic resonance (MR) image shows with large gastric varices (GV) with gastrorenal shunt (arrow). (B) After balloon inflation, GV (arrow) are then embolized using sodium tetradecyl sulfate (Sotradecol; AngioDynamics, Queensbury, NY, USA) mixed with Lipiodol (Ethiodol; Savage Laboratories, Melville, NY, USA). The occlusion balloon is found to be ruptured and she have continuous gastric variceal bleeding. Two days after balloon-occluded retrograde transvenous obliteration, she underwent transjugular intrahepatic portosystemic shunts (TIPS) procedure. (C) Initial portal venogram shows retrograde filling of the GV from the left gastric vein (arrow). (D) TIPS stent is successfully placed and left gastric vein is embolized with multiple coils (arrow). (E) Four months after TIPS procedure, she underwent TIPS reduction procedure due to hepatic encephalopathy with resulting central narrowing (arrow). (F) Twenty-seven months follow-up coronal MR image shows complete obliteration of GV.
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