Transjugular intrahepatic portosystemic shunt using transsplenic access with balloon-assisted puncture technique in a patient with chronic and complete occlusion of portal vein

Abstract : A 62-year-old female patient was diagnosed with cryptogenic cirrhosis complicated by development of portal vein thrombosis. The patient had resultant refractory ascites and high risk esophageal varices that were unable to be controlled by endoscopic management. While a transjugular intrahepatic portosystemic shunt was indicated, the anatomy was complicated by cavernous transformation of portal vein and splenic vein occlusion, making a conventional transjugular approach challenging. Therefore, a percutaneous transsplenic access with a balloon-assisted puncture technique was used to successfully create a transjugular intrahepatic portosystemic shunt.