Transjugular Intrahepatic Portosystemic Shunt Creation in Isolated Persistent Left Superior Vena Cava and Portal Vein Thrombosis

Isolated persistent left superior vena cava is a rare congenital venous anomaly. It imposes technical challenges and increased risks in patients requiring a transjugular intrahepatic portosystemic shunt. The patient was a 67-year-old man with cirrhosis, recurrent large-volume ascites, hepatic hydrothorax, and portal vein thrombosis. The patient had a history of failed transjugular intrahepatic portosystemic shunt creation using a conventional CO₂ portal venography technique via a left jugular vein access. The patient underwent successful transjugular intrahepatic portosystemic shunt creation under fluoroscopy and intravascular ultrasound guidance. The patient required transjugular intrahepatic portosystemic shunt revision with mechanical thrombectomy in 2 months. Intravascular ultrasound can provide additional live information to assist transjugular intrahepatic portosystemic shunt creation in patients with complex congenital venous anatomy, including those with isolated persistent left superior vena cava.