From the Division of Vascular and Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054.
Radiographics. 2022 Sep-Oct;42(5):1562-1576. doi: 10.1148/rg.220042. Epub 2022 Aug 19.
Multiple diseases of the portal system require effective portal vein access for endovascular management. While percutaneous transhepatic and transjugular approaches remain the standard methods of portal vein access, transsplenic access (TSA) has gained recognition as an effective and safe technique to access the portal system in patients with contraindications to traditional approaches. Recently, the utility of percutaneous TSA has grown, with described treatments including recanalization of chronic portal vein occlusion, placement of stents for portal vein stenosis, portal vein embolization of the liver, embolization of gastric varices, placement of complicated transjugular intrahepatic portosystemic shunts, and interventions after liver transplant. The authors provide a review of percutaneous TSA, including indications, a summary of related portal vein diseases, and the different techniques used for access and closure. In addition, an imaging-based review of technical considerations of TSA interventions is presented, with a review of potential procedural complications. With technical success rates that mirror or rival the standard methods and reported low rates of major complications, TSA can be a safe and effective option in clinical scenarios where traditional approaches are not feasible. RSNA, 2022.
多种门静脉系统疾病需要有效的门静脉入路进行血管内治疗。虽然经皮经肝和经颈静脉途径仍然是门静脉入路的标准方法，但脾内途径（transsplenic access，TSA）已被认为是一种有效且安全的技术，可以在传统方法有禁忌的患者中进入门静脉系统。最近，经皮 TSA 的应用越来越广泛，其描述的治疗方法包括慢性门静脉闭塞的再通、门静脉狭窄支架置入、门静脉栓塞治疗、胃静脉曲张栓塞、复杂经颈静脉肝内门体分流术的放置以及肝移植后的介入治疗。作者对经皮 TSA 进行了综述，包括适应证、相关门静脉疾病概述以及用于入路和关闭的不同技术。此外，还基于影像学对 TSA 介入的技术要点进行了综述，并回顾了潜在的程序并发症。与标准方法的技术成功率相当或相媲美，且报告的主要并发症发生率低，因此，在传统方法不可行的临床情况下，TSA 可以是一种安全有效的选择。RSNA，2022 年。
