Iatrogenic Portal Venous Circulatory Injuries in the IR Suite.

Abstract

Advanced portal venous interventions including transjugular intrahepatic portosystemic shunts, variceal sclerotherapy, and portal venous recanalization are more widely performed, as more aggressive approaches to manage portal hypertension increase patient candidacy for liver transplantation and other therapies. Initial percutaneous portal access may be achieved through transjugular, transsplenic, and transhepatic accesses. Although rare, a potentially life-threatening complication from these approaches is hemorrhage from venous perforation.[1] [2] Patients with portal hypertension often have tortuous vascular anatomy, weakened vessel walls, and high portal venous pressures, predisposing them to potentially devastating outcomes if this complication is encountered. As such, interventional radiologists must take extra precaution to avoid venous injuries during advanced portal venous interventions.[3] [4] Herein we present two patients who experienced rapid, dramatic decompensation from intraperitoneal hemorrhage after initial access was achieved. These cases provide an overview of the clinical course and management strategies for this rare complication in the hopes of improving patient outcomes.