Fig. 4. Plug-assisted retrograde transvenous obliteration. (A) A 10-Fr long sheath was advanced into the gastrorenal shunt (GRS). A venogram demonstrated a giant GRS. (B, C) Collaterals from the inferior phrenic vein were super-selected and embolized with microcoils. (D) A 22-mm Amplatzer Vascular Plug (AVP) was deployed distally within the GRS. The AVP was pulled down and positioned so that the middle lobe was sealed at the waist. (E) A follow-up venogram showed residual flow through a recess between the AVP and the GRS wall. After thrombus formation, the varices were embolized with large gelatin sponge particles. (F) The completion venogram confirmed occlusion of the GRS and patency of the left renal venous return. Noted that additional coils were used to occlude the most proximal segment and to stabilize the AVP.
© Int J Gastrointest Interv
pISSN 2636-0004
