case_images: PMC4684853_01
case_images: (a) Digital subtraction angiography of a type 2 Abernethy malformation. Injection of contrast into the splenic vein revealed marked flow of contrast into a patent portal vein (star), the portosystemic shunt (horizontal arrow), and the IVC (arrowhead). (b) Fluoroscopic placement of aortic endograft within the IVC. Introduction of the aortic endograft (arrow) into the IVC occluded the communication between the portosystemic shunt and systemic venous system. Care was taken not to occlude the renal or hepatic veins. (c) Postprocedure cavagram. Digital subtraction venography demonstrates a patent inferior vena cava after endograft placement at T12-L1. The inferior aspect of the graft can be visualized in satisfactory position superior to the renal vein inflow bilaterally (arrowheads).
case_images: CRIRA2015-491867.001.jpg
case_images: PMC4684853_01_CRIRA2015-491867.001.jpg
case_images: fig1
case_images: IVC, allowing for shunt visualization (Figure 1(a)). In order to assess the patency of the portal system, transjugular pressure measurements were obtained prior to the procedure. Following serial dilations at the internal jugular vein, a 20 F sheath was introduced, and a 32 mm x 39 mm Zenith Flex stent graft was deployed (Figure 1(b)), excluding the connection of the shunt to the IVC. A venacavogram was performed after balloon dilatation of the stent (Figure 1(c)) demonstrating exclusion of the portal-caval shunt.