Transjugular intrahepatic portosystemic shunt in cirrhosis: An exhaustive critical update

Figure 2 Fluoroscopic spot image demonstrating the “combined approach” to management of a patient with intractable gastric variceal bleeding due to IGV1 and severely attenuated portal vein. A type-II amplatzer vascular plug (encircled) has been deployed within the gastrorenal shunt retrogradely through the jugular route with vascular access sheath (dashed arrow) in situ. Subsequently, a catheter (solid arrow) was used to inject the sclerosant mixture into the shunt (arrowheads) antegrade through the transjugular intrahepatic route. The transjugular intrahepatic portosystemic shunt stent was then placed in the usual way within the intrahepatic tract after ensuring stasis of sclerosant mixture within the shunt and detachment of the vascular plug.