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Change in the Hemodynamics of the Portal Venous System After Retrograde Transvenous Balloon Occlusion of a Gastrorenal Shunt

Takuji Yamagami1, Takeharu Kato, Shigeharu Iida, Osamu Tanaka and Tsunehiko Nishimura

1 All authors: Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-chyo, Kawaramachi-Hirokoji, Kamigyo, Kyoto 602-8566, Japan.



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  		Fig. 1A. —61-year-old woman with gastric varices caused by liver cirrhosis. Splenic arteriograph obtained during portal phase shows hepatofugal portal flow originating from spleen flowing through short gastric vein and entering gastrorenal shunt (thin arrow) and left renal vein and inferior vena cava (thick arrow). Hepatopetal portal flow is not seen.

 


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  		Fig. 1B. —61-year-old woman with gastric varices caused by liver cirrhosis. Splenic arteriograph obtained during portal phase with balloon occlusion of gastrorenal shunt fails to reveal gastrorenal shunt, despite inflow from short gastric vein into gastric region and normal hemodynamics of portal venous system (arrows). Inferior vena cava is not visualized.

 


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  		Fig. 1C. —61-year-old woman with gastric varices caused by liver cirrhosis. CT arterial portograph acquired through splenic artery with balloon occlusion of gastrorenal shunt reveals well-opacified portal venous system in liver (arrows) and minimal amount of contrast material in inferior vena cava.

 


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  		Fig. 1D. —61-year-old woman with gastric varices caused by liver cirrhosis. CT arterial portograph acquired through splenic artery without balloon occlusion of gastrorenal shunt shows poor enhancement of portal venous system in liver and dense opacification of inferior vena cava (thick arrow) and gastrorenal shunt (thin arrow). Enhancement of liver parenchyma is not as pronounced as depicted on C.

 

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