# Double-Access Strategy for Chronic Portal Vein Thrombosis: Salvage Recanalization via Transsplenic and Transhepatic Routes

## TL;DR

A rare case of chronic portal vein thrombosis after liver transplant was successfully treated using a dual-access endovascular strategy to restore blood flow.

## Contribution

Demonstrates a novel dual-access endovascular approach for treating complex chronic PVT in post-transplant patients.

## Key findings

- Combined transhepatic and transsplenic access enabled successful recanalization of the portal vein.
- Stent deployment restored portal venous flow and reduced collateral circulation.
- The procedure achieved technical success without major complications.

## Abstract

Chronic portal vein thrombosis (PVT) with cavernous transformation is a rare but serious complication after liver transplantation, often associated with portal hypertension and gastrointestinal (GI) bleeding. We report the case of a 47-year-old female liver transplant (LT) recipient with recurrent bleeding and imaging findings of chronic PVT. Despite extensive evaluation, no active bleeding source was identified. Given persistent symptoms and portal hypertensive changes, portal vein recanalization (PVR) was attempted. A combined transhepatic and transsplenic approach enabled through-and-through access across the occlusion. Sequential balloon angioplasty and deployment of a covered stent with overlapping bare-metal stents restored portal venous flow and reduced collateral circulation. Technical success was achieved, with no major complications apart from a self-limited perisplenic hematoma managed with embolization. This case demonstrates the feasibility and effectiveness of a dual-access endovascular strategy for complex chronic PVT with cavernous transformation in post-transplant patients.