39 year old patient with alcoholic cirrhosis who presents with UGI bleeding secondary to gastric and esophageal varices.
Comment: Once a TIPS procedure has been performed, it is our hope that the portosystemic pressure gradient would be <12 mm Hg. At times, esophageal varices remain visible on venography, despite a therapeutic pressure gradient. When this occurs in a patient who presented initially with variceal bleeding, we try and embolize those varices to further reduce the risk of future bleeding.