BALLOON OCCLUSION PORTOGRAPHY TO DIAGNOSE NEW-ONSET LEFT HEPATIC VEIN-THROMBOSIS AND WIDENING OF AN EXISTING WALLSTENT TIPS BY PALMAZ STENTS FOR RECURRENT PORTAL-HYPERTENSION AND VARICEAL BLEEDING

A 31-year-old man with Child's class A micronodular cirrhosis, left lo be hypertrophy, and a transjugular intrahepatic portosystemic shunt (T IPS) which had been placed 6 months earlier, was admitted for recurren t esophageal bleeding and a portosystemic gradient of 42 mmHg. Balloon occlusion portography documented unsuspected ostial thrombosis of the previously patent left hepatic vein. This was considered the cause of the pressure rise, As it was not possible to insert a second TIPS in parallel, the shunt, stented originally with 10-mm Wallstents, was ove rdilated to 12 mm, and two 12-mm Palmaz stents were placed coaxially, reducing the portosystemic pressure gradient to 13 mmHg.