Embolization of a paraumbilical shunt by the transparaumbilical venous approach and one-sheath inverse method: A case report

Abstract

We describe treatment of a 53-year-old man with chronic hepatic encephalopathy. Contrast-enhanced computed tomography demonstrated a recanalized paraumbilical vein as a portosystemic shunt connecting the left branch of the portal vein and bilateral iliac veins. Percutaneous embolization was performed. The paraumbilical vein was punctured under ultrasonographic guidance; a 7-Fr sheath was inserted in the cranial direction. The hepatic side of the shunt was embolized with a vascular plug. The sheath direction was inverted to the caudal side; the pelvic side of the shunt was then embolized with another vascular plug. This report demonstrates that the percutaneous transparaumbilical venous approach is useful and safe for portosystemic shunt intervention. Moreover, the one-sheath inverse method was useful for embolization of upstream and downstream sides of the puncture site.

Percutaneous Antegrade Transvenous Variceal Obliteration for Portal Vesiculopathy-Related Gross Hematuria

“…We managed the present case successfully using plug-assisted antegrade transvenous obliteration for managing of gastric varices, primarily due to ease of access to the shunt through the recanalized paraumbilical vein. An alternative approach could be a percutaneous transhepatic obliteration technique as described by Sato et al 12 Our technique was similar to Kamada et al 1 including paraumbilical vein access and one sheath inversion technique for shunt occlusion in a patient with recurrent hepatic encephalopathy.…”

“…3 ). A 5F K.M.P catheter (Cook Medical, Bloomington, Indiana, United States) was advanced caudally over a 0.035” hydrophilic guidewire using the “one-sheath inversion technique” where in the same access was used to redirect the catheter caudally into the vesical end of the paraumbilical vein 1 ( Fig. 4 ).…”