160653.fig.001a
(a)
160653.fig.001b
(b)
160653.fig.001c
(c)
160653.fig.001d
(d)
160653.fig.001e
(e)
160653.fig.001f
(f)
Figure 1: (a) Portography from the superior mesenteric artery shows the hepatofugal flow in the splenic vein and a large splenorenal shunt (arrowhead). (b) The venous phase of a selective splenic arteriogram shows that the splenic venous blood flows into the left renal vein via the splenorenal shunt (arrow). (c) A device (Coil Anchor, Medikit Co., Miyazaki, Japan) (arrowhead) to prevent migration of the coils has been placed. After the placement of this device, one 0.035-inch platinum coil was placed (arrow). (d) Selective splenovenography after embolization of the splenic vein shows the development of a hepatofugal collateral, retrogastric vein (arrow), connected to the splenorenal shunt. This collateral was embolized with 2 microcoils. (e) Portography from the superior mesenteric artery after embolization demonstrates a clear depiction of portal branches and no splenorenal shunt. There was hepatofugal flow via the coronary vein (double arrow), but it was not embolized to avoid increasing portal pressure. (f) Venous blood ammonia levels measured after the procedure. The patient had encountered no symptoms of hepatic coma for 24 months after procedure.