Direct access of intra-abdominal veins, feasibility, safety and clinical applications

To evaluate the feasibility, safety, and clinical applications of ultrasound-guided direct percutaneous access to ectatic abdominal veins for the embolization of vascular malformations. The medical records, imaging studies, and procedural details were retrospectively reviewed for patients who underwent embolization procedures for vascular malformations with ultrasound-guided percutaneous access to intraabdominal veins, including pelvic, retroperitoneal, and portomesenteric veins. A total of 38 direct percutaneous vein accesses were performed across 25 procedures in 9 patients (age range: 3-58 years). Access sites included retroperitoneal veins (n=12), dilated and tortuous internal iliac vein branches (n=8), the superior mesenteric vein (n=8), the inferior mesenteric vein (n=1), ileocolic vein (n=8), and right colic vein (n=1). Catheter sizes ranged from 3 to 5 French. All procedures were technically successful. Seven minor access-related complications occurred, all managed conservatively. Ultrasound-guided percutaneous access to dilated intraabdominal veins is feasible and associated with minimal morbidity. It offers a valuable alternative in patients with complex vascular malformations requiring access to deep abdominal veins.