Percutaneous Transsplenic Stent Placement to Treat Portal Vein Occlusion in a Pediatric Liver Transplant Recipient

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In recent years, percutaneous endovascular intervention has become the primary treatment for pediatric post-liver transplantation portal vein stenosis. This procedure is usually performed using a transhepatic approach. Herein, we report the transsplenic endovascular management of a 3-year-old girl with post-liver transplantation, late-onset portal vein occlusion, which occurred after repeated percutaneous transhepatic angioplasty procedures. Transhepatic access was precluded by thrombosis, and we considered an ileocecal approach too invasive; therefore, we performed a portal vein recanalization by puncturing a collector branch of the splenic vein, dilating the portal vein thrombotic stenosis using a balloon, and inserting a self-expanding stent. The majority of percutaneous procedures for portal vein stenosis in children are transhepatic; however, our case demonstrates that transsplenic stent insertion is possible, and should be considered when the transhepatic approach is precluded.