Fig. 1. (A, B) A pre-interventional contrast-enhanced magnetic resonance imaging of abdomen. Magnetic resonance image demonstrated cirrhosis, varices, and thrombosis involving the main, right, and left portal veins with cavernous transformation. (C) Initial splenoportography. Splenoportography demonstrated prominent esophageal varices and cavernous transformation of the portal vein. (D?G) Sequential steps of procedure; (D) Fogarty occlusion balloon filled with contrast was used as a target and punctured by a long Chiba needle (Cook Medical). (E) The balloon was successfully punctured. Successful access could be confirmed by contrast leakage. (F) A wire was placed through the Chiba needle. A snare captures the wire, and pulled it out of splenic sheath. (G) Final angiography after transjugular intrahepatic portosystemic shunt (TIPS) creation demonstrates patency of TIPS and improvement of flow through the splenic vein, without filling of the varices. Portosystemic pressures gradient dropped to 6 mmHg. (H) At the completion of the procedure, the transsplenic tract was embolized with two MReye Embolization coils (Cook Medical).
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