A. Portal vein thrombosis

The fluoroscopy shows reflux of contrast into the portal system via a feeding short gastric vein. Further injection would cause sclerosant to reflux into the portal system causing thrombosis. This is why some operators advocate for using a gelfoam slurry rather than sclerosants because the gelfoam would theoretically cause a temporary thrombosis with reflux rather than the more permanent and potent sclerosant.

After injection of the sclerosant, the shunt outflow was occluded with a single Amplatzer plug, preserving the left adrenal venous outflow. Some studies have suggested that plug-assisted retrograde transvenous obliteration is most cost-effective relative to coil-assisted or traditional balloon-assisted. It also has the advantage of less streak artifact on follow up CTs than coils.