Fig. 9. A 62-year-old female with a history of hepatitis C induced cirrhosis presents with refractory encephalopathy despite maximal medical management. Axial (A) and coronal (B) contrast-enhanced computed tomography images demonstrate large recanalized paraumbilical vein which follows a markedly tortuous course to the umbilicus. (C) Angiographic images demonstrate coil-assisted retrograde transvenous obliteration-variant procedure where venous access was obtained trans-abdominally directly into the peripheral aspect of the periumbilical collateral. After a coil-embolization was performed at the central and peripheral aspect of the periumbilical collateral; the entire length was embolized using gelfoam to ensure complete obliteration of the shunt.
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