Premium
Percutaneous transportal outflow‐vessel‐occluded sclerotherapy for gastric varices unmanageable by balloon‐occluded retrograde transvenous obliteration
Author(s) -
Kawai Nobuyuki,
Minamiguchi Hiroki,
Sato Morio,
Ikoma Akira,
Sanda Hiroki,
Nakata Kouhei,
Tanaka Takami,
Nakai Motoki,
Sonomura Tetsuo
Publication year - 2013
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/j.1872-034x.2012.01078.x
Subject(s) - medicine , gastric varices , sclerotherapy , varices , radiology , embolization , transjugular intrahepatic portosystemic shunt , percutaneous , balloon , varix , catheter , portal hypertension , surgery , cirrhosis
In this report we introduce percutaneous transportal outflow‐vessel‐occluded sclerotherapy (PTOS) for gastric varices unmanageable by balloon‐occluded retrograde transvenous obliteration (BRTO) in two cases and evaluate its safety and efficacy. The PTOS is a technique which could obstruct gastric varices subsequent to the occlusion of the outflow route, being based on the rationale of BRTO. In the PTOS procedure, coil embolization of the outflow vessel is first conducted through a microcatheter advanced beyond the gastric varices via the percutaneous transhepatic approach; sclerosing agent (5% ethanolamine oleate) is then injected into the gastric varices after confirmation of static blood flow in the varices. Two patients underwent initial BRTO that eventually failed because of the presence of numerous fine and abruptly angled outflow vessels (case 1), and the presence of a tortuous and elongated outflow vessel accompanied by numerous small collateral outflows that could not be occluded (case 2). Cases 1 and 2 received PTOS using 5% ethanolamine oleate (15 mL and 10 mL, respectively). Portal venous pressure following PTOS showed an increase from 29 to 34 mmHg in case 1 and remained at 24 mmHg in case 2. No major complication was encountered in either patient. One‐year follow‐up gastroendoscopy showed no recurrence of gastric varices in either patient. Although PTOS is slightly more invasive than BRTO, PTOS can be used as an alternative catheter treatment procedure for gastric varices that are unmanageable by BRTO.