Keywords:
Abdomen, Interventional vascular, CT-Angiography, Fluoroscopy, Catheter venography, Computer Applications-3D, Embolisation, Cirrhosis, Varices
Authors:
J. Koizumi1, T. Hashimoto2, K. Myojin2, C. Itou2, T. Ichikawa2, B. Janne d'Othee3; 1Isehara-City, Kanagawa-pref./JP, 2Isehara/JP, 3Baltimore, MD/US
DOI:
10.1594/ecr2011/C-2006
Purpose
Gastroduodenal varices remain a problematic condition due to the threat of rupture and bleeding and to their association with massive portosystemic shunting and potential hepatic encephalopathy.
The efficacy of transjugular intrahepatic portosystemic shunts (TIPS) is limited in this indication.
Balloon-occluded retrograde transvenous obliteration (BRTO) [1,
2] or dual balloon occlusion embolotherapy (DBOE) [3] have become attractive alternatives that can play an important role in the treatment of gastric varices,
in addition to endoscopic,
surgical,
or other endovascular therapies.
To perform BRTO,
the left renal vein and gastrorenal shunt are catheterized with a Fogarty-type catheter and balloon-occluded left adrenal venography (BOAV) is obtained,
followed by infusion of a sclerosant to occlude the gastric varices.
In order to obtain complete thrombosis of the target gastric varices by BRTO,
access to the efferent (draining) vein and adequate variceal filling by the sclerosant are essential.
Indeed,
obliteration of the drainage vein without thrombosis of the upstream gastric varices may instead increase pressure in the varices,
which can subsequently rupture.
However,
it is often difficult to distinguish by conventional venography the efferent vein and vulnerable gastric varices that project into the gastric lumen from the adjacent veins.
Therefore,
flat panel detector angiographic computed tomography (FACT) during BRTO was introduced to plan and verify access to the efferent vein and to confirm adequate filling of the target gastric varices by contrast media and the subsequent sclerosant.