LAUSR

Dear Editor, Taking a case as an example, we would like to present here a diverted use of the radiofrequency ablation to stop a hepatic bleeding. Percutaneous puncture of an intrahepatic portal vein is currently used in order to treat portal vein stenosis/thrombosis and portal hypertension-related bleeding. After these procedures, significant bleeding can occur through the puncture tract. Consequently, embolization of trans-parenchymal puncture tract is recommended. However, even if intrahepatic access tract is embolized, severe bleeding is sometimes observed [1–3]. Literature focusing on iatrogenic portal vein bleeding is scarce without guidelines of care [4]. We report a severe portal bleeding after a portal branch access successfully treated using radiofrequency ablation of the bleeding tract. A 66-year-old female with esogastric varices due to portal hypertension was referred to our institution for hematemesis. Endoscopic treatment was attempted, complicated by massive hemorrhage. Transjugular intrahepatic portocaval shunt was contraindicated because of pulmonary arterial hypertension, so a percutaneous transhepatic varices embolization was performed with a right transhepatic portal 8-French access sheath closed by one coil. Later, a multiphasic contrast-enhanced CT scan, performed because of hemodynamic instability, showed a venous active bleeding at the hepatic puncture site and coil migration (Fig. 1). Due to hemodynamic instability, a new transhepatic portal access was not appropriated. Emergent