Percutaneous Retroperitoneal Splenorenal Shunt Creation After Failed Pvr-Tips Attempt

Percutaneous Retroperitoneal Splenorenal Shunt Creation After Failed Pvr-Tips Attempt | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Percutaneous Retroperitoneal Splenorenal Shunt Creation After Failed Pvr-Tips Attempt Bryan Nicholas Swilley This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7888732/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Feb, 2026 Read the published version in CVIR Endovascular → Version 1 posted 4 You are reading this latest preprint version 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 with subsequent 6 month follow-up. TIPS PVR-TIPS PRESS variceal hemorrhage portal hypertension Figures Figure 1 Figure 2 Figure 3 Figure 4 BACKGROUND Upper gastrointestinal bleeding remains a significant cause of morbidity and mortality in patients with portal hypertension. Approximately 50% of patients with cirrhosis develop gastroesophageal varices. [ 1 ] Gastric varices cause approximately 10–30% of variceal hemorrhage. 35–90% of gastric varices rebleed after initial hemostasis. [ 2 ] TIPS creation provides initial hemostasis in up to 90% of patients with bleeding gastric varices, and pre-emptive TIPS after initial endoscopic control of variceal hemorrhage has shown a 25% absolute risk reduction in mortality. [ 3 , 4 ] TIPS and BRTO performed together can further reduce the risk of rebleeding. [ 5 ] Chronic portal vein occlusion can add technical complexity to TIPS creation, but PVR-TIPS can be performed successfully in up to 98% with advanced techniques. [ 6 ] For cases of bleeding gastroesophageal varices that are not candidates for PVR-TIPS, PRESS has been described as a new technique to create an extrahepatic portosystemic shunt. [ 7 – 9 ] CASE PRESENTATION A 62 year old male with history of Child Pugh A cirrhosis complicated by portal vein thrombosis with cavernous transformation on Eliquis for 7 years initially presented to an outside hospital with bleeding gastric and esophageal varices. Endoscopy revealed grade 3 esophageal varices, large gastric varices and portal hypertension gastrostomy. The outside facility attempted TIPS creation, unsuccessfully. The patient was felt to have no reasonable surgical or interventional radiology options at the outside facility, so he was then referred to Emory for TIPS creation. At the time of presentation to Emory, he was Child Pugh A. MELD 8. BMI 27.4 kg/m2. After PVR-TIPS was discussed at a clinic visit, attempted PVR-TIPS was unsuccessful. Options of partial splenic embolization and/or percutaneous retroperitoneal splenorenal shunt (PRESS) creation were discussed. He elected to try PRESS with partial splenic embolization as a last resort. Careful pre-procedure review of cross-sectional imaging revealed proximity of the main splenic vein to a spontaneous gastro-adrenal shunt. The spontaneous gastro-renal shunt required blood to pass through and pressurize gastric varices. This was chosen as the point of target from the splenic vein to the renal vein. Written informed consent was obtained before the procedure. Trans-splenic access was obtained using a Greb access set, with subsequent exchange of the Greb catheter for a 6 French vascular sheath. Left common femoral arterial and venous access were also obtained, with 6 French vascular sheath placements into each. A SOS catheter was used to access the celiac access and advanced into the splenic artery for visualization of the splenic artery during splenorenal shunt creation. A Simmons 2 catheter was used in the right common femoral vein sheath to select the left renal vein and then the spontaneous gastro-renal shunt outflow. Over a Rosen wire, the Simmons 2 catheter and vascular sheath were exchanged for an 8.5 French x 55 cm Bayliss Passport steerable sheath was advanced into the left renal vein for increased stability. A 20 mm Gooseneck snare was then positioned within the gastro-renal shunt outflow through the Passport sheath. Next, Cobra 2 catheter was used through the trans-splenic access to target the snare with a Bayliss radiofrequency guidewire under fluoroscopic guidance. After securement of the radiofrequency wire with the snare, it was pulled through the common femoral vein sheath for body floss. A 4 French Terumo Navicross catheter was then advanced across the radiofrequency wire, and the radiofrequency wire was exchanged for the exchange length Rosen wire. Via the common femoral vein access sheath, a 9 mm x 10 cm Viabahn stent graft was positioned and deployed across the splenorenal shunt tract. The splenorenal shunt was then post-dilated with an angioplasty balloon. Venogram through the sheath and delayed splenic arteriogram demonstrated patent flow across the new splenorenal shunt. The splenic access tract was closed with a 5–7 mm MVP vascular plug and 1:1 lipiodol:glue mixture. The common femoral arterial access was closed with Angioseal, and hemostasis of the left common femoral vein access was achieved with manual compression. The patient was then transported to the intensive care unit for post-procedure observation. That evening, he reported feeling great and was able to get out of bed. He was discharged three days later. He reported doing well at his two month follow up visit, and doppler ultrasound at that time demonstrated patency of the splenorenal shunt. At 6 months, he still felt well, and CT with IV contrast demonstrated continued patency of the splenorenal shunt. CONCLUSIONS Although surgical splenorenal shunt creation has existed since 1947 and has been studied extensively, percutaneous retroperitoneal splenorenal shunt creation provides a novel approach for decompression of portal hypertension in patients who are not candidates for TIPS or PVR-TIPS. [ 10 ] Much of the existing literature about PRESS lacks long-term follow up. This report demonstrates a case in which PRESS has been well tolerated and remained patient for 6 months. PRESS remains an interesting type of extrahepatic porto-systemic shunt creation that merits additional research as a possible alternative in cases when TIPS cannot be created. Abbreviations TIPS transjugular intrahepatic portosystemic shunt PVR TIPS–portal vein recanalization with transjugular intrahepatic portosystemic shunt PRESS percutaneous retroperitoneal splenorenal shunt. Declarations ETHICS STATEMENTS AND CONSENT TO PARTICIPATE: Not applicable. CONSENT FOR PUBLICATION: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. AVAILABILITY OF DATA AND MATERIALS: Not applicable COMPETING INTERESTS: The author declares that they have no competing interests. FUNDING: None. AUTHOR CONTRIBUTIONS: BNS – Methodology, conceptualization, writing, review and editing. ACKKNOWLEDGEMENTS: Not applicable. References Tari E, Frim L, Stolcz T, Teutsch B, Veres DS, Hegyi P, Erőss B (2023) At admission hemodynamic instability is associated with increased mortality and rebleeding rate in acute gastrointestinal bleeding: A systematic review and meta-analysis. Ther Adv Gastroenterol 16:17562848231190970 Wani ZA, Bhat RA, Bhadoria AS, Maiwall R, Choudhury A (2015) Gastric varices: Classification, endoscopic and ultrasonographic management. J Res Med Sci 20(12):1200–1207. 10.4103/1735-1995.172990 PMID: 26958057; PMCID: PMC4766829 Chau TN, Patch D, Chan YW et al (1998) Salvage transjugular intrahepatic portosystemic shunts: gastric fundal compared with esophageal variceal bleeding. Gastroenterology 114:981–987 Garcia-Pagan JC, Caca K, Bureau C et al (2010) Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 362:2370–2379 Saad WE (2014) Combining Transjugular Intrahepatic Portosystemic Shunt with Balloon-Occluded Retrograde Transvenous Obliteration or Augmenting TIPS with Variceal Embolization for the Management of Gastric Varices: An Evolving Middle Ground? Semin Intervent Radiol 31:266–268 Thornburg B, Desai K, Hickey R, Kulik L, Ganger D, Baker T, Abecassis M, Lewandowski RJ, Salem R (2016) Portal Vein Recanalization and Transjugular Intrahepatic Portosystemic Shunt Creation for Chronic Portal Vein Thrombosis: Technical Considerations. Tech Vasc Interv Radiol 19(1):52–60. 10.1053/j.tvir.2016.01.006 Epub 2016 Feb 6. PMID: 26997089 Pulitano C, Rogan C, Sandroussi C, Verran D, McCaughan GW, Waugh R, Crawford M (2015) Percutaneous Retroperitoneal Splenorenal Shunt for Symptomatic Portal Vein Thrombosis After Liver Transplantation. Am J Transplant 15:2261–2264. https://doi.org/10.1111/ajt.13243 Frenk NE, Irani Z, Elias N, Ganguli S, Yamada K (2019) Transplenic Splenorenal Shunt via the Left Adrenal Vein. J Vasc Interv Radiol 30(10):1615–1617e1. 10.1016/j.jvir.2018.12.005 Epub 2019 Apr 17. PMID: 31005488 Tamas JW et al Percutaneous Splenorenal Shunt Creation in a Patient with Chronic Portomesenteric Thrombosis. J Vasc Interv Radiol, 31, Issue 9, 1408–1409 Shah OJ, Robbani I (2005) A simplified technique of performing splenorenal shunt (Omar's technique). Tex Heart Inst J 32(4):549–554 PMID: 16429901; PMCID: PMC1351828 Cite Share Download PDF Status: Published Journal Publication published 28 Feb, 2026 Read the published version in CVIR Endovascular → Version 1 posted Reviewers agreed at journal 03 Nov, 2025 Reviewers invited by journal 03 Nov, 2025 Editor assigned by journal 24 Oct, 2025 First submitted to journal 20 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7888732","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":539304663,"identity":"a05ea9ec-5880-43a4-a101-bcee3ef6a231","order_by":0,"name":"Bryan Nicholas 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11:09:04","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":35630,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7888732/v1/7caf2292f573a00bb1e05162.html"},{"id":95825537,"identity":"8ed92ecc-bb24-4dc5-8ca0-615f55bfbcc7","added_by":"auto","created_at":"2025-11-13 11:09:05","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":158446,"visible":true,"origin":"","legend":"\u003cp\u003ea demonstrates large gastric varices (blue arrow). Figure 1b shows proximity of splenic vein (yellow arrow) to outflow of spontaneous gastro-adrenal shunt (green arrow).\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7888732/v1/022b09406f15f909232e7cec.jpeg"},{"id":95825522,"identity":"2cead481-d348-4fbc-b6a6-ac7221498555","added_by":"auto","created_at":"2025-11-13 11:09:03","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":132770,"visible":true,"origin":"","legend":"\u003cp\u003ea demonstrates splenic venogram after initial trans-splenic access. Figure 2b demonstrates the power wire passing from the Cobra 2 catheter within the splenic vein to the snare within the gastro-adrenal shunt outflow. Figure 2c demonstrates simultaneous venogram through trans-splenic sheath and left common femoral vein sheath to show the shunt length. Figure 2d and 2e shows patency of the stent after deployment of the Viabahn stent within the shunt tract. Figure 2f shows the MVP plug and glue tract embolization from this procedure and the prior PVR-TIPS attempt.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7888732/v1/bea32e608ee9d517711f3ebf.jpeg"},{"id":95825532,"identity":"bf606467-a933-4498-88f0-91402db2a258","added_by":"auto","created_at":"2025-11-13 11:09:04","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":124405,"visible":true,"origin":"","legend":"\u003cp\u003edemonstrates doppler ultrasound at 2 months post-PRESS creation. Figure 3a shows grayscale image of the spleen and splenorenal shunt. Figure 3b-3d show patent color and spectral doppler flow within the splenic vein and splenorenal shunt.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7888732/v1/761875570a6c8a559d9eb0e3.jpeg"},{"id":95825536,"identity":"f6717345-0e09-4463-a340-c6d77ded5059","added_by":"auto","created_at":"2025-11-13 11:09:05","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":243933,"visible":true,"origin":"","legend":"\u003cp\u003edemonstrates 6 month patency of the splenorenal shunt (blue arrow).\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7888732/v1/9f23241601615bbbdec15535.jpeg"},{"id":103765591,"identity":"1e04727e-558c-43cd-a93e-a573973829f2","added_by":"auto","created_at":"2026-03-02 16:05:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":888078,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7888732/v1/1ef09f96-8e3d-4d70-8a05-14eff3f69478.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003ePercutaneous Retroperitoneal Splenorenal Shunt Creation After Failed Pvr-Tips Attempt\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eUpper gastrointestinal bleeding remains a significant cause of morbidity and mortality in patients with portal hypertension. Approximately 50% of patients with cirrhosis develop gastroesophageal varices. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] Gastric varices cause approximately 10\u0026ndash;30% of variceal hemorrhage. 35\u0026ndash;90% of gastric varices rebleed after initial hemostasis. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] TIPS creation provides initial hemostasis in up to 90% of patients with bleeding gastric varices, and pre-emptive TIPS after initial endoscopic control of variceal hemorrhage has shown a 25% absolute risk reduction in mortality. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] TIPS and BRTO performed together can further reduce the risk of rebleeding. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Chronic portal vein occlusion can add technical complexity to TIPS creation, but PVR-TIPS can be performed successfully in up to 98% with advanced techniques. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] For cases of bleeding gastroesophageal varices that are not candidates for PVR-TIPS, PRESS has been described as a new technique to create an extrahepatic portosystemic shunt. [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e"},{"header":"CASE PRESENTATION","content":"\u003cp\u003eA 62 year old male with history of Child Pugh A cirrhosis complicated by portal vein thrombosis with cavernous transformation on Eliquis for 7 years initially presented to an outside hospital with bleeding gastric and esophageal varices. Endoscopy revealed grade 3 esophageal varices, large gastric varices and portal hypertension gastrostomy. The outside facility attempted TIPS creation, unsuccessfully. The patient was felt to have no reasonable surgical or interventional radiology options at the outside facility, so he was then referred to Emory for TIPS creation. At the time of presentation to Emory, he was Child Pugh A. MELD 8. BMI 27.4 kg/m2.\u003c/p\u003e\u003cp\u003eAfter PVR-TIPS was discussed at a clinic visit, attempted PVR-TIPS was unsuccessful. Options of partial splenic embolization and/or percutaneous retroperitoneal splenorenal shunt (PRESS) creation were discussed. He elected to try PRESS with partial splenic embolization as a last resort.\u003c/p\u003e\u003cp\u003eCareful pre-procedure review of cross-sectional imaging revealed proximity of the main splenic vein to a spontaneous gastro-adrenal shunt. The spontaneous gastro-renal shunt required blood to pass through and pressurize gastric varices. This was chosen as the point of target from the splenic vein to the renal vein. Written informed consent was obtained before the procedure.\u003c/p\u003e\u003cp\u003eTrans-splenic access was obtained using a Greb access set, with subsequent exchange of the Greb catheter for a 6 French vascular sheath. Left common femoral arterial and venous access were also obtained, with 6 French vascular sheath placements into each. A SOS catheter was used to access the celiac access and advanced into the splenic artery for visualization of the splenic artery during splenorenal shunt creation. A Simmons 2 catheter was used in the right common femoral vein sheath to select the left renal vein and then the spontaneous gastro-renal shunt outflow. Over a Rosen wire, the Simmons 2 catheter and vascular sheath were exchanged for an 8.5 French x 55 cm Bayliss Passport steerable sheath was advanced into the left renal vein for increased stability. A 20 mm Gooseneck snare was then positioned within the gastro-renal shunt outflow through the Passport sheath.\u003c/p\u003e\u003cp\u003eNext, Cobra 2 catheter was used through the trans-splenic access to target the snare with a Bayliss radiofrequency guidewire under fluoroscopic guidance. After securement of the radiofrequency wire with the snare, it was pulled through the common femoral vein sheath for body floss. A 4 French Terumo Navicross catheter was then advanced across the radiofrequency wire, and the radiofrequency wire was exchanged for the exchange length Rosen wire. Via the common femoral vein access sheath, a 9 mm x 10 cm Viabahn stent graft was positioned and deployed across the splenorenal shunt tract. The splenorenal shunt was then post-dilated with an angioplasty balloon. Venogram through the sheath and delayed splenic arteriogram demonstrated patent flow across the new splenorenal shunt.\u003c/p\u003e\u003cp\u003eThe splenic access tract was closed with a 5\u0026ndash;7 mm MVP vascular plug and 1:1 lipiodol:glue mixture. The common femoral arterial access was closed with Angioseal, and hemostasis of the left common femoral vein access was achieved with manual compression.\u003c/p\u003e\u003cp\u003eThe patient was then transported to the intensive care unit for post-procedure observation. That evening, he reported feeling great and was able to get out of bed. He was discharged three days later. He reported doing well at his two month follow up visit, and doppler ultrasound at that time demonstrated patency of the splenorenal shunt. At 6 months, he still felt well, and CT with IV contrast demonstrated continued patency of the splenorenal shunt.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eAlthough surgical splenorenal shunt creation has existed since 1947 and has been studied extensively, percutaneous retroperitoneal splenorenal shunt creation provides a novel approach for decompression of portal hypertension in patients who are not candidates for TIPS or PVR-TIPS. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Much of the existing literature about PRESS lacks long-term follow up. This report demonstrates a case in which PRESS has been well tolerated and remained patient for 6 months. PRESS remains an interesting type of extrahepatic porto-systemic shunt creation that merits additional research as a possible alternative in cases when TIPS cannot be created.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTIPS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003etransjugular intrahepatic portosystemic shunt\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePVR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTIPS\u0026ndash;portal vein recanalization with transjugular intrahepatic portosystemic shunt\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePRESS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003epercutaneous retroperitoneal splenorenal shunt.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eETHICS STATEMENTS AND CONSENT TO PARTICIPATE:\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eCONSENT FOR PUBLICATION:\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and any accompanying images.\u003c/p\u003e\n\u003cp\u003eAVAILABILITY OF DATA AND MATERIALS:\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eCOMPETING INTERESTS:\u003c/p\u003e\n\u003cp\u003eThe author declares that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFUNDING:\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003eAUTHOR CONTRIBUTIONS:\u003c/p\u003e\n\u003cp\u003eBNS \u0026ndash; Methodology, conceptualization, writing, review and editing. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eACKKNOWLEDGEMENTS:\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTari E, Frim L, Stolcz T, Teutsch B, Veres DS, Hegyi P, Erőss B (2023) At admission hemodynamic instability is associated with increased mortality and rebleeding rate in acute gastrointestinal bleeding: A systematic review and meta-analysis. Ther Adv Gastroenterol 16:17562848231190970\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWani ZA, Bhat RA, Bhadoria AS, Maiwall R, Choudhury A (2015) Gastric varices: Classification, endoscopic and ultrasonographic management. J Res Med Sci 20(12):1200\u0026ndash;1207. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/1735-1995.172990\u003c/span\u003e\u003cspan address=\"10.4103/1735-1995.172990\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 26958057; PMCID: PMC4766829\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChau TN, Patch D, Chan YW et al (1998) Salvage transjugular intrahepatic portosystemic shunts: gastric fundal compared with esophageal variceal bleeding. Gastroenterology 114:981\u0026ndash;987\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGarcia-Pagan JC, Caca K, Bureau C et al (2010) Early use of TIPS in patients with cirrhosis and variceal bleeding. 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Am J Transplant 15:2261\u0026ndash;2264. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/ajt.13243\u003c/span\u003e\u003cspan address=\"10.1111/ajt.13243\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFrenk NE, Irani Z, Elias N, Ganguli S, Yamada K (2019) Transplenic Splenorenal Shunt via the Left Adrenal Vein. J Vasc Interv Radiol 30(10):1615\u0026ndash;1617e1. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jvir.2018.12.005\u003c/span\u003e\u003cspan address=\"10.1016/j.jvir.2018.12.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003eEpub 2019 Apr 17. PMID: 31005488\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTamas JW et al Percutaneous Splenorenal Shunt Creation in a Patient with Chronic Portomesenteric Thrombosis. J Vasc Interv Radiol, 31, Issue 9, 1408\u0026ndash;1409\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShah OJ, Robbani I (2005) A simplified technique of performing splenorenal shunt (Omar's technique). Tex Heart Inst J 32(4):549\u0026ndash;554 PMID: 16429901; PMCID: PMC1351828\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"cvir-endovascular","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cire","sideBox":"Learn more about [CVIR Endovascular](https://www.springer.com/journal/42155)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/cire/default.aspx","title":"CVIR Endovascular","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"TIPS, PVR-TIPS, PRESS, variceal hemorrhage, portal hypertension","lastPublishedDoi":"10.21203/rs.3.rs-7888732/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7888732/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eGastric 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 with subsequent 6 month follow-up.\u003c/p\u003e","manuscriptTitle":"Percutaneous Retroperitoneal Splenorenal Shunt Creation After Failed Pvr-Tips Attempt","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-13 11:08:44","doi":"10.21203/rs.3.rs-7888732/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2025-11-03T15:44:13+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-03T15:36:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-24T11:44:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"CVIR Endovascular","date":"2025-10-20T23:10:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"cvir-endovascular","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cire","sideBox":"Learn more about [CVIR Endovascular](https://www.springer.com/journal/42155)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/cire/default.aspx","title":"CVIR Endovascular","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"81694089-4b0c-4c1c-a371-1d69eb4f243d","owner":[],"postedDate":"November 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-02T16:02:00+00:00","versionOfRecord":{"articleIdentity":"rs-7888732","link":"https://doi.org/10.1186/s42155-026-00663-1","journal":{"identity":"cvir-endovascular","isVorOnly":false,"title":"CVIR Endovascular"},"publishedOn":"2026-02-28 15:58:39","publishedOnDateReadable":"February 28th, 2026"},"versionCreatedAt":"2025-11-13 11:08:44","video":"","vorDoi":"10.1186/s42155-026-00663-1","vorDoiUrl":"https://doi.org/10.1186/s42155-026-00663-1","workflowStages":[]},"version":"v1","identity":"rs-7888732","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7888732","identity":"rs-7888732","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}