Efficacy and Safety of Surgical Ligation versus Endovascular Embolization for Type II Congenital Extrahepatic Portosystemic Shunt

Figure 3

Images in a 54-year-old male diagnosed with type II CEPS with HE who underwent endovascular embolization. (a) Anteroposterior VR image reconstructed from CTA data prior to occlusion shows portal vein and its fine intrahepatic branches (green), IVC (blue), and tortuous and dilated portal vein-iliac vein shunt via the paraumbilical vein (red). (b) Sagittal VR image shows portal vein and its branches (green) IVC (blue) and the shunt (red). (c) Sagittal maximum intensity projection at the portal venous phase demonstrates the portal vein, IVC, and the shunt, in accordance with the VR findings. (d) Indirect portal venography via SMA demonstrates portal venous outflow drained into a tortuous and dilated shunt (black arrow). (e) Portal venography demonstrates partial hypoplastic intrahepatic portal venous veins (white arrow) and the communication between the portal vein and right iliac vein (dotted arrow) via the shunt (black arrow). (f) Portal venography with balloon occlusion shows hypoplastic intrahepatic portal veins (white arrow). The PVP is 21.7 and 24.3 mmHg before and 15 min after balloon occlusion, respectively. (g) The shunt was embolized with Amplatzer plug (curved arrow). (h) Preoperative contrast-enhanced CT image demonstrates the dilated main portal vein (arrowhead) and the hypoplastic intrahepatic portal vein branches (white arrow). (i) CT scan shows portal vein thrombosis (arrowhead) at 1 month after the procedure which disappeared after seven-day anticoagulation therapy. (j) Contrast-enhanced CT images demonstrate the main portal vein shrinking into normal level (arrowhead), and the intrahepatic portal veins (white arrow) grow well at 12 months after interventional occlusion. (k) CT scan demonstrates that the intrahepatic portal veins (white arrow) grow well at 36 months after the procedure.

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