# Percutaneous Transhepatic Variceal Embolization as a Therapeutic Bridge for Variceal Bleeding: An Initial Alternative in the Absence of Endoscopy or Transjugular Intrahepatic Portosystemic Shunt (TIPS)

## TL;DR

A new treatment called percutaneous transhepatic variceal embolization helps stop dangerous bleeding in cirrhosis patients when standard methods aren't available.

## Contribution

PTVE is proposed as a novel bridge therapy for variceal bleeding in resource-limited settings.

## Key findings

- PTVE achieved immediate hemostasis and hemodynamic stabilization in a cirrhosis patient.
- PTVE can serve as an alternative when endoscopy or TIPS are unavailable.
- The combined coil and Onyx strategy was effective in controlling variceal bleeding.

## Abstract

Variceal gastrointestinal bleeding in patients with liver cirrhosis is a potentially fatal complication that requires prompt hemostatic control. Standard management includes vasoactive therapy, antibiotic prophylaxis, and urgent endoscopic intervention, with transjugular intrahepatic portosystemic shunt reserved for selected high-risk or refractory cases. However, in resource-limited settings, timely access to endoscopy or definitive portal decompression may be delayed or unavailable, increasing the risk of hemodynamic deterioration and early mortality. We report the case of a 64-year-old woman with cirrhosis who developed hypovolemic shock secondary to gastroesophageal variceal hemorrhage and was treated with percutaneous transhepatic variceal embolization (PTVE) using a combined coil and ethylene-vinyl alcohol copolymer (Onyx) strategy, achieving immediate hemostasis and hemodynamic stabilization. This case highlights PTVE as a feasible bridge therapy in acute variceal bleeding when endoscopic or definitive portal decompression strategies are delayed or unavailable.