CASE

A 63-year-old patient with no significant past medical history presents with hemodynamically significant hematemesis. He is intubated in the emergency department and undergoes CT and endoscopy showing cirrhotic liver morphology with a largely isolated gastrorenal shunt associated with a large proximal gastric varix. There is no ascites or history of encephalopathy. MELD 9. Normal RV function on echocardiography. There are sequelae of recent bleeding on endoscopy with blood in the stomach. Due to the size, the endoscopist was unable to treat the varix and places an IR consult for transvenous obliteration.