ABSTRACT
Although the large majority of cases are anatomically favorable and therefore technically feasible, congenital or acquired conditions may complicate or even preclude successful creation of a transjugular intrahepatic portosystemic shunt (TIPS). The present report describes the use of the inferior right hepatic vein from a femoral vein access to obtain portal access and place a covered stent, reconstruct a partially occluded portal vein, and embolize large gastric varices in a patient with a persistent left superior vena cava (SVC) and absent right SVC.
Subject(s)
Esophageal and Gastric Varices/surgery , Femoral Vein , Portasystemic Shunt, Surgical/methods , Stents , Catheterization , Esophageal and Gastric Varices/etiology , Female , Humans , Hypertension, Portal/complications , Middle Aged , Phlebography , Polytetrafluoroethylene , Portasystemic Shunt, Surgical/instrumentation , Tomography, X-Ray Computed , Vena Cava, Superior/abnormalitiesABSTRACT
Caput medusa is a frequent incidental finding in patients with portal hypertension that usually represents paraumbilical vein portosystemic collateral vessels draining into body wall systemic veins. A symptomatic caput medusa was seen in a morbidly obese patient after an umbilical hernia repair, which was fed not by the left portal vein but by the left gastroepiploic vein, in a recurrent adhesed umbilical hernia that likely contained herniated omentum. Refractory hemorrhage from this caput medusa was successfully treated by transjugular intrahepatic portosystemic shunt creation and balloon-occluded variceal sclerosis.
