Combined Transhepatic and Transsplenic Recanalization of Chronic Portal Vein Occlusion to Treat Jejunal Varices: A Report of Two Cases.

We report two cases of chronic portal vein occlusion with jejunal varices successfully treated using percutaneous intervention with a combined transhepatic and transsplenic approach. Case 1 was a 60-year-old man with uncontrolled jejunal variceal bleeding, and case 2 was a 79-year-old man with anastomotic jejunal variceal bleeding and cholangitis. Single access via the transhepatic or transsplenic route failed to allow catheter advancement through the occlusion. After introducing pull-through access via the transhepatic and transsplenic routes, a metallic stent was could be used to dilate the occluded portal vein. Anastomotic jejunal varices functioning as hepatopetal collaterals were embolized after the establishment of antegrade portal flow. No symptom relapse was observed during the follow-up period (31 months for case 1 and 34 months for case 2).

Treatment of Periorbital and Palpebral Arteriovenous Malformations.

Objectives: To clarify clinically challenging palpebral arteriovenous malformations (AVMs) and to propose a novel therapeutic modality, we developed a multi-disciplinary approach for the management of AVMs with ulcer. Approach: First, the central retinal artery was secured with embolization by the transophthalmic arterial, a terminal branch of the internal carotid artery (ICA), and then, the branches of the external carotid artery (ECA) were embolized to cause a response in the AVM vasculature followed by sclerotherapy and surgery. Results: Over a 3-year follow-up of palpebral and periorbital AVMs in four females and one male 20 to 50 years of age with a mean age of 38 years, complete remission of the lesions were seen with no major complication, such as blindness, ptosis, or cerebral infarction, with functionally sound and esthetically acceptable results, with no recurrence or worsening even with one case of ulceration postembolization. Innovation: Planned treatment of palpebral and periorbital AVMs, which have been often left untreated because of their complex vasculature and a risk of total blindness due to occlusion of the central retinal artery. A "wait-and-watch" approach is frequently taken. It is important to secure the periphery to the bifurcation of the central retinal artery of the ICA, and then, embolization through the ECA results in complete remission of the lesion, followed by sclerotherapy and surgery, which are successful both in terms of function and esthetics. Conclusion: First, securing the central retinal artery leads to safer and complete resolution of palpebral and periorbital AVMs; wounding or therapeutic complications such as skin necrosis may be seen, but this approach results in complete remission in 3 years with no major complications.