Korean J Radiol.  2013 Jun;14(3):439-445. 10.3348/kjr.2013.14.3.439.

The Role of Divided Injections of a Sclerotic Agent over Two Days in Balloon-Occluded Retrograde Transvenous Obliteration for Large Gastric Varices

• Yamagami T
• Yoshimatsu R
• Miura H
• Matsumoto
• Hasebe T

• KMID: 1705456
• DOI: http://doi.org/10.3348/kjr.2013.14.3.439

Abstract

OBJECTIVE
To determine the safety and usefulness of a two-tiered approach to balloon-occluded retrograde transvenous obliteration (B-RTO) as a treatment for large gastric varices after portal hypertension.
MATERIALS AND METHODS
50 patients were studied who underwent B-RTO for gastric varices between October 2004 and October 2011 in our institution. The B-RTO procedure was performed from the right femoral vein and the B-RTO catheter was retained until the following morning. Distribution of sclerotic agents in the gastric varices on fluoroscopy was evaluated in all patients on days 1 and 2. When distribution of sclerotic agents in the gastric varices on day 1 had been none or very scanty even though the volume of the sclerotic agent infused was above the acceptable level, a second infusion was administered on day 2. When distribution was satisfactory, the B-RTO catheter was removed.
RESULTS
In 8 (16%) patients, little or no sclerotic agent infused on day 1 was distributed in the gastric varices. However, on day 2, sclerotic agents were distributed in all gastric varices. Mean volume of ethanolamine oleate-iopamidol infused on day 1 was 24.6 mL and was 19.4 mL on day 2. Gastric varices were well obliterated with no recurrence. Complications caused by the sclerotic agent such as pulmonary edema or renal insufficiencies were not seen.
CONCLUSION
When gastric varices are very large, a strategy involving thrombosis of only the drainage vein on the first day followed by infusing the sclerotic agent on the following day might be effective and feasible.

Keyword

Portal veins; Stomach, varices; Therapeutic blockade

MeSH Terms

Adult
Aged
Aged, 80 and over
Balloon Occlusion/*methods
Catheters, Indwelling
Collateral Circulation
Drug Administration Schedule
Esophageal and Gastric Varices/etiology/radiography/*therapy
Female
Femoral Vein
Gastrointestinal Hemorrhage/etiology/*therapy
Humans
Hypertension, Portal/*complications
Iopamidol/*administration & dosage/adverse effects
Male
Middle Aged
Oleic Acids/*administration & dosage/adverse effects
Recurrence
Retrospective Studies
Sclerosing Solutions/*administration & dosage/adverse effects
Tomography, X-Ray Computed
Iopamidol
Oleic Acids
Sclerosing Solutions

Figure

• 

  Fig. 1 68-year-old man with gastric varix (patient no. 8 in table).A. Fluoroscopic image obtained after infusion of sclerotic agent from balloon catheter positioned at gastro-renal shunt shows no distribution of sclerotic agent in gastric varix. Note that left inferior phrenic vein that developed as collateral vein had been embolized with micro-coils (arrow). B. Retrograde venography obtained with balloon occlusion of gastro-renal on day 2 shows that contrast material is distributed in entire gastric varix (arrow) through gastro-renal shunt that had been thrombosed in some but not all areas. C. Enhanced CT before balloon-occluded transvenous obliteration shows that intravenously administered contrast agent allows visualization of varix in gastric walls (arrow). D. Enhanced CT obtained 6 days after balloon-occluded transvenous obliteration shows well-thrombosed gastric varix (arrow).

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