Gun-sight technique for recanalization of chronic noncirrhotic, nonmalignant extrahepatic portal vein obstruction

Portal hypertension resulting from thrombosis of the noncirrhotic extrahepatic portal vein is a rare cause with high morbidity and mortality related to complications of portal hypertension. Portal vein recanalization is a technique aimed at restoring hepatic blood flow, however, its viability may be limited by the complexity of the occlusion. This case report describes a portal vein recanalization using the gun-sight technique, which involves placing loops in the intrahepatic and extrahepatic portal veins to serve as targets for percutaneous needle advancement after failure of portal vein recanalization via conventional access. Percutaneous portal vein recanalization with transsplenic and transhepatic access, combined with guided targeting, is a technically feasible method with short-term patency and clinical improvement for the treatment of chronic portal vein thrombosis.