A 43 year old cirrhotic patient was referred for management of recurrent bleeding secondary to portal hypertension.
He had several sitting of endoscopic ligatures and sclerotherapy in the past.
Clinically he had ascites and biochemical features of cirrhosis with poor liver function he was suggested liver transplantation in the future.
Image shows injection in the portal vein from a needle that was navigated from the jugular into the hepatic vein and the portal vein accessed by passing the needle through the intervening liver tissue.
It shows a dilated portal vein and dilated A guide wire was then passed through the needle and the needle exchanged for a balloon which was used to dilate the tract in the liver tissue between the two vessels.
The tract was further treated with a special metal tubular mesh to ensure its patency (Stent Graft).
The post procedure Angiogram shows good flow through the stent and no further filling of the abnormal vessel.
The patient made a remarkable recovery and was discharged the next morning tortuous veins in the stomach