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.