# Percutaneous retroperitoneal splenorenal shunt creation after failed PVR-TIPS attempt

## TL;DR

This paper describes a medical case where a new shunt was created to treat variceal bleeding when a standard procedure failed.

## Contribution

The paper presents a novel PRESS shunt technique for decompressing the portal venous system when TIPS is not feasible.

## Key findings

- PRESS shunt was successfully created from the splenic vein to the left adrenal vein.
- The procedure provided decompression in a patient with chronic portal vein thrombosis.
- The patient showed stable outcomes during a 6-month follow-up period.

## Abstract

Gastric and esophageal variceal bleeding causes significant morbidity and mortality. TIPS creation is one of many methods to treat and reduce the risk of variceal hemorrhage. In such cases where TIPS cannot be created, percutaneous retroperitoneal splenorenal shunt (PRESS) creation serves as one alternative to decompress the portal venous system. This case highlights a case of PRESS creation from splenic vein to left adrenal vein as a method to decompress the splanchnic venous system in cases of chronic portal vein thrombosis with cavernous transformation when PVR-TIPS fails, with subsequent 6 month follow-up.