Successful management of refractory gastric variceal bleeding via a combined percutaneous approach in sinistral portal hypertension

Amongst less common upper gastrointestinal bleeding causes is gastric variceal bleeding due to sinistral portal hypertension. A patient with a history of acute myeloid leukemia and subsequent splenic vein thrombosis presented with melena due to gastric varices bleeding. After failure of medical and endoscopic approach and given that he was not a TIPS candidate, a percutaneous approach was attempted. A transhepatic catheterization and ectopic varices embolization initially stabilized him, but bleeding relapsed. A splenic artery embolization was performed that led to permanent management of the bleeding.