case_images: PMC10769814_01
case_images: The images of contrast-enhanced abdominal computed tomography (CT) and operation procedures of ultrasound-guided percutaneous transhepatic interventional closure. (A) Contrast-enhanced abdominal CT with three-dimensional reconstruction in Case 1 shows an almost normal portal vein with a dilated inferior mesenteric vein connection between the splenic vein and the right internal iliac vein and obvious rectal varices in the pelvis. (B) Operation procedures in Case 1. Percutaneous transhepatic portal vein puncture was performed under ultrasound guidance, followed by insertion of a 4 French sheath. Portal pressure was measured at ~11 mmHg. After angiography confirmed shunt blood flow to the right internal iliac vein, four interlocking coils were inserted anterogradely into the inferior mesenteric vein to embolize the shunt. Repeat angiography showed that the shunt blood flow velocity was significantly slowed. Portal pressure was measured again at ~15 mmHg and recovered to 12 mmHg after 20 minutes. (C) Contrast-enhanced abdominal CT in Case 2 shows an almost normal portal vein with a dilated inferior mesenteric vein communicating with the left internal iliac vein. (D) Operation procedures in Case 2. The patient underwent anterograde angiography of the inferior mesenteric vein after percutaneous transhepatic puncture of the portal vein under ultrasound guidance, which was confirmed to be connected to the bilateral internal iliac vein; thus, the diagnosis of Type 2 Abernethy malformation was considered. Then, three interlocking coils were inserted anterogradely along the portal vein to the distal end of the inferior mesenteric vein to embolize the shunt. Repeat angiography showed that the shunt blood flow velocity was significantly slowed. The portal pressure was measured at ~24 mmHg and recovered to 21 mmHg after 20 minutes.
case_images: goad075f1.jpg
case_images: PMC10769814_02_goad075f1.jpg
case_images: goad075-F1
case_images: T1-weighted imaging in the globus pallidus. The diagnosis of Type 2 Abernethy malformation was confirmed by using abdominal CT, which revealed an almost normal portal vein with a dilated inferior mesenteric vein communicating with the left internal iliac vein (Figure 1C). Interventional closure via a transhepatic approach was chosen after multidisciplinary consultation and the procedures were successful (Figure 1D).
case_images: PMC10769814_02
case_images: The images of contrast-enhanced abdominal computed tomography (CT) and operation procedures of ultrasound-guided percutaneous transhepatic interventional closure. (A) Contrast-enhanced abdominal CT with three-dimensional reconstruction in Case 1 shows an almost normal portal vein with a dilated inferior mesenteric vein connection between the splenic vein and the right internal iliac vein and obvious rectal varices in the pelvis. (B) Operation procedures in Case 1. Percutaneous transhepatic portal vein puncture was performed under ultrasound guidance, followed by insertion of a 4 French sheath. Portal pressure was measured at ~11 mmHg. After angiography confirmed shunt blood flow to the right internal iliac vein, four interlocking coils were inserted anterogradely into the inferior mesenteric vein to embolize the shunt. Repeat angiography showed that the shunt blood flow velocity was significantly slowed. Portal pressure was measured again at ~15 mmHg and recovered to 12 mmHg after 20 minutes. (C) Contrast-enhanced abdominal CT in Case 2 shows an almost normal portal vein with a dilated inferior mesenteric vein communicating with the left internal iliac vein. (D) Operation procedures in Case 2. The patient underwent anterograde angiography of the inferior mesenteric vein after percutaneous transhepatic puncture of the portal vein under ultrasound guidance, which was confirmed to be connected to the bilateral internal iliac vein; thus, the diagnosis of Type 2 Abernethy malformation was considered. Then, three interlocking coils were inserted anterogradely along the portal vein to the distal end of the inferior mesenteric vein to embolize the shunt. Repeat angiography showed that the shunt blood flow velocity was significantly slowed. The portal pressure was measured at ~24 mmHg and recovered to 21 mmHg after 20 minutes.
case_images: goad075f1.jpg
case_images: PMC10769814_02_goad075f1.jpg
case_images: goad075-F1
case_images: T1-weighted imaging in the globus pallidus. The diagnosis of Type 2 Abernethy malformation was confirmed by using abdominal CT, which revealed an almost normal portal vein with a dilated inferior mesenteric vein communicating with the left internal iliac vein (Figure 1C). Interventional closure via a transhepatic approach was chosen after multidisciplinary consultation and the procedures were successful (Figure 1D).