Percutaneous transsplenic balloon dilatation for stenotic distal splenorenal shunt.

A 27 year old cirrhotic male underwent stenosis of the distal splenorenal shunt to treat bleeding of esophageal varices. Percutaneous transluminal angioplasty was performed first by catheterization of the right femoral vein, but without success. Therefore, a direct puncture of the splenic vein through the spleen was made, under sonographic guidance, followed by balloon dilatation of the stenotic anastomosis. The pressure of the splenic vein before and after PTA was 35 and 29 cm H2O, respectively. Both the follow-up barium esophagogram and esophagoscopy showed marked regression of the esophageal varices.