Portal Vein Recanalization and Embolization of the Transsplenic Puncture Tract Using an Amplatzer® Vascular Plug: a Case Report

Background: A transsplenic access for the catheterization of the portal venous system to treat a portal vein thrombosis and/or stenosis entails the risk of intra-abdominal or intrasplenic bleeding complications and has to be seen as an approach of last resort. This is one of few reported cases in the literature where a transsplenic puncture tract was successfully embolized using an Amplatzer® vascular plug 4 (8 mm; St. Jude Medical).

Case Presentation: This is the case report of a 58 years old Caucasian male patient who had received right sided extended hemihepatectomy with partial resection of the portal vein due to hilar cholangiocarcinoma three years ago. The patient suffered from portal hypertension with difficult controllable bleeding of esophageal varices due to chronically progressive thrombosis of the portal vein caused by chronic anastomosis stenosis of the reconstructed left portal vein branch (confirmed in a Magnetic Resonance Imaging (MRI) examination 6 months after the portal vein reconstruction). A transsplenic access (6 French) was chosen to allow recanalization of the portal vein, stent-angioplasty of the anastomosis and coiling of the gastric varices. The transsplenic tract was successfully embolized with an Amplatzer® Vascular Plug 4 and gelfoam pledgets.

Conclusion: Amplatzer® Vascular plugs in combination with gelatin sponges can be used to efficiently and precisely seal transsplenic puncture sites.