Portal vein angioplasty using a transjugular, intrahepatic approach for treatment of extrahepatic portal vein stenosis after liver transplantation

Symptomatic portal vein stenosis is an uncommon complication after liver tr ansplantation. Portal vein angioplasty has been successfully established fo r treatment of portal vein stenosis using mesenteric or percutaneous, trans hepatic approaches. We herein report on a patient who suffered from varicea l bleeding due to portal hypertension 3 months after liver transplantation. After successful endoscopic sclerotherapy, an extrahepatic portal vein ste nosis was diagnosed, and portal vein angioplasty was considered as primary therapeutic option. Instead of mesenteric or percutaneous, transhepatic app roaches, we adopt ed a transjugular, intrahepatic access to introduce a 14- mm balloon catheter into the portal vein. Using this technique, angioplasty was successfully performed. After intervention, no further episodes of var iceal bleeding occurred. We favour the transjugular, intrahepatic technique for portal vein angioplasty because it does not require general anesthesia , in contrast to the mesenteric approach, and it reduces the risk of intra- abdominal bleeding, compared to the percutaneous, transhepatic approach.