Multiple diseases of the portal system require effective portal vein (PV) access for endovascular management. While percutaneous transhepatic or transjugular approaches remain the standard method of PV access, the transsplenic approach has gained recognition as an effective and safe technique in patients with contraindications to traditional approaches.
Material(s) and Method(s):
Described treatments amenable to percutaneous transsplenic access (PTA) include recanalization of chronic PV occlusion, stenting of PV stenosis, portal vein embolization (PVE), embolization of gastric varices, or transjugular intrahepatic portosystemic shunt (TIPS) and post-liver transplant interventions.
We will provide a review of PTA indications based on existing evidence within the literature, and a summary of related PV diseases. Additionally an imaging based review of technical considerations of PTA, and discussion of potential procedural complications is also presented.
PTA is increasingly being utilized for portal venous interventions, specifically as related to recanalization in chronic PV occlusion, stenting of portal vein stenosis, pre-operative PVE, complex TIPS procedures, and variceal embolization. In clinical scenarios in which a traditional transhepatic approach is not feasible in patients requiring portal intervention, PTA has been shown to be a generally safe technique with high technical success rates. Bleeding complications remain the primary adverse event in PTA interventions; further research is needed to clarify if an ideal method of access and tract embolization exists that may minimize postprocedural hemorrhage rates.