Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy

Figure 16 Coil-assisted retrograde transvenous obliteration of gastric varices in a 55-year-old patient who presented with recurrent gastric variceal bleeding refractory to endoscopic therapy. A: Angled catheter was navigated into the left gastrorenal shunt after obtaining access from the right common femoral vein and advancing 5-french sheath into the inferior vena cava; B: Digital subtraction angiography performed through the gastrorenal shunt demonstrating large dilated shunt vessels, as well as, secondary outflow through pericardiophrenic collaterals; C: Both the proximal and distal shunts were coil-occluded and gelfoam was utilized to embolize and thrombose the gastric varices.