Percutaneous Transhepatic Variceal Embolization as a Therapeutic Bridge for Variceal Bleeding: An Initial Alternative in the Absence of Endoscopy or Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Variceal gastrointestinal bleeding in patients with liver cirrhosis is a potentially fatal complication that requires prompt hemostatic control. Standard management includes vasoactive therapy, antibiotic prophylaxis, and urgent endoscopic intervention, with transjugular intrahepatic portosystemic shunt reserved for selected high-risk or refractory cases. However, in resource-limited settings, timely access to endoscopy or definitive portal decompression may be delayed or unavailable, increasing the risk of hemodynamic deterioration and early mortality. We report the case of a 64-year-old woman with cirrhosis who developed hypovolemic shock secondary to gastroesophageal variceal hemorrhage and was treated with percutaneous transhepatic variceal embolization (PTVE) using a combined coil and ethylene-vinyl alcohol copolymer (Onyx) strategy, achieving immediate hemostasis and hemodynamic stabilization. This case highlights PTVE as a feasible bridge therapy in acute variceal bleeding when endoscopic or definitive portal decompression strategies are delayed or unavailable.