This is a 71-year-old woman with cryptogenic liver cirrhosis without histological confirmation (MELD 6; Child-Pugh A6) with several previous episodes of varicose hemorrhage in the previous two years attributed to LV with prolongations.
The previous endoscopic approach confirmed variceal eradication with sequential combination of ligation with bands and with N-butyl-2-cyanoacrylate (NBC).
Under optimized medical treatment, the hepatic venous pressure gradient was 15 mmHg.
The sports axis was always permeable in the semiannual Doppler ultrasounds.
He presented an additional hemorrhagic episode, this time secondary to rupture of a SG, not previously described, which was treated urgently with NBC (2 cc) prior to delayed insertion of a TIPS.
During the procedure a partial radioscopy and indirect portal vein thrombosis (PT), radiopaque, was detected in the fluoroscopy, which was confirmed by direct portography; the TIPS allowed the pressure gradient to be 8 mmHg.
In periodic controls and controls, the mean flow velocity in the portal vein (40 cm/s) and inside the TIPS (100 cm/s) remained correct after 12 months of follow-up.
