Disabling portosystemic encephalopathy in a non-cirrhotic patient: Successful endovascular treatment of a giant inferior mesenteric-caval shunt via the left internal iliac vein

Figure 1 Volume rendering CECT (portal phase). Showing the giant porto-systemic shunt, patent portal and splenic veins and no gastro-esophageal varices. The shunt extends from the inferior part of the spleno-mesenteric confluence to the left hypogastric vein. Enlarged calibre of the superior mesenteric vein is visible at the confluence.

Figure 2 Direct venography from right femoral vein approach, by a 5 Fr diagnostic catheter, of the porto-systemic shunt. Confirming the presence of the retroperitoneal loop with a hepatofugal flow to the left internal iliac vein.

Figure 3 Completion angiography. Shunt exclusion after endovascular embolization by detachable coils and two plugs and patency of the left internal iliac vein and inferior vena cava.

Figure 4 Follow up MIP (maximum intensity projection) computed tomography at 1 mo. Pointed out the patency of the superior mesenteric, splenic and portal veins. Coils cast and plugs, proximal and distal, completely excluded shunt’s flow. Platinum coils-related artifacts are evident above the nitinol plug. The course of aorta parallel to superior mesenteric vein is depicted.