Indications and opportunities for transsplenic access to treat portal venous and portosystemic pathology: A report of 2 cases and review of the literature.

Transsplenic access has emerged as a valuable technique for portal venous interventions when conventional transjugular or transhepatic approaches are challenging due to prohibitive anatomy. We briefly summarize the literature on how transsplenic access came to be and present 2 unique cases that highlight the importance of transsplenic access in facilitating transjugular intrahepatic portosystemic shunt creation in complex portal venous disease. The first case describes a 68-year-old male cirrhotic patient with extensive acute-on-chronic portal vein thromboses in whom transsplenic access enabled portal vein thrombectomy and successful portosystemic shunt placement. The second case involves a 60-year-old female patient with chronic portal vein thrombosis and cavernous transformation, where a combined transsplenic-transhepatic "body floss" technique allowed recanalization and subsequent portosystemic shunt creation.