Clinical Presentation

The patient is a 56-year-old man with cirrhosis and bleeding gastroesophageal varices who is in the intensive care unit.

(A) Right hepatic (arrow) venogram–wedged (portal) pressure can be measured at this time. (B) Portal venous puncture and cannulation (arrow) at least 1 cm above the portal bifurcation, optimally. (C) Tract dilation with an 8-mm-diameter balloon (arrow). (D) Deployment of a covered stent (Viatorr stent: arrow). (E) Follow-up venogram (arrow); dilate stent if narrow. (F) Variceal venography: persistent antegrade flow despite a transjugular intrahepatic portosystemic shunt (TIPS: arrow). (G) Venography after coil (arrow) embolization.

Differential Diagnosis

• Transjugular intrahepatic portosystemic shunt and variceal embolization

Imaging Findings