Rationale: Vascular involvement manifests as aneurysms, stenosis, and arteriovenous malformations in patients with type I neurofibromatosis (NF-I). Aneurysms are rare; however, the renal artery is the most common site. Herein, we report a rare case of stent graft placement in an anterior tibial artery (ATA) pseudoaneurysm in a patient with NF-I. Patient concerns: A 52-year-old woman with NF-1 was admitted to the emergency room with painful swelling in the left lower leg. At presentation, the patient’s blood pressure was 100/60 mmHg and the hemoglobin level was 9 g/dL. Diagnoses: Computed tomography scan revealed a small aneurysm arising from the left ATA and an adjacent large hematoma. Intervention: Stent graft placement was performed to treat ATA pseudoaneurysm. Outcomes: After stent graft placement, the aneurysm disappeared and the distal flow was patent through the ATA. Lessons: Stent graft placement should be considered as another option for endovascular treatment in patients in whom coil embolization or surgery cannot be performed.

Rationale: Plug-assisted retrograde transvenous obliteration (PARTO) or coil-assisted retrograde transvenous obliteration (CARTO) are alternative treatments for gastric variceal bleeding and hepatic encephalopathy. Both procedures have fewer complications related to balloon rupture or sclerosing agents and are shorter than balloon-occluded retrograde transvenous obliteration. Herein, we report a case of PARTO and CARTO was performed simultaneously to treat refractory hepatic encephalopathy in a patient with 2 portosystemic shunts. Patient concerns: A 59-year-old man with alcoholic liver cirrhosis presented to the emergency room with mental change. At presentation, the patient’s plasma ammonia level was 340 μg/dL. Diagnoses: A computed tomography scan revealed perisplenic collateral vessels and 2 splenorenal shunts. Intervention: PARTO and CARTO were performed to treat hepatic encephalopathy via the 2 splenorenal shunts. Outcomes: A follow-up computed tomography scan showed the splenorenal shunt was successfully embolized using a vascular plug and coil. After 3 weeks, the patient’s plasma ammonia level decreased to 80 μg/dL, and repeated hospitalizations due to hepatic encephalopathy ceased. Lessons: Depending on the patient’s anatomy, PARTO and CARTO can be performed simultaneously and, similar to balloon-occluded retrograde transvenous obliteration, are useful for treating hepatic encephalopathy.

Ratinale: Plug-assisted retrograde tansvenous obliteration (PARTO) is commonly used to treat gastric variceal bleeding. PARTO is typically performed via the gastrorenal shunt or gastrocaval shunt and there have been no reports of PARTO performed through the pericardial vein in cases of gastric varices in which there is no gastrorenal or gastrocaval shunt. Herein, we report a case of PARTO was performed to treat gastric variceal bleeding in a patient with a gastric varix without a gastrorenal or gastrocaval shunt. Patient concerns: A 54-year-old man with alcoholic liver cirrhosis presented to the emergency room with hematemesis and melena. At presentation, the patient’s blood pressure was 130/70 mm Hg and hemoglobin level was 10.1 g/dL. Diagnoses: Computed tomography (CT) scan and endoscopic examination revealed a gastric varix at the gastric fundus. Interventions: PARTO was performed to treatment of gastric variceal bleeding via the pericardial vein. Outcomes: The patient did not show any signs of variceal bleeding after the procedure, and follow-up CT at 3 weeks showed complete resolution of the gastric varix. Lessons: Although PARTO is technically difficult to perform through pathways other than the gastrorenal or gastrocaval shunt, it can be a beneficial alternative in cases in which other treatments fail or are not feasible.