Korean J Radiol.  2014 Oct;15(5):630-636. 10.3348/kjr.2014.15.5.630.

Percutaneous Access via the Recanalized Paraumbilical Vein for Varix Embolization in Seven Patients

Affiliations
  • 1Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea. angioint
  • 2Department of Radiology, Dongsan Hospital, Keimyung University College of Medicine, Daegu 700-712, Korea.

Abstract


OBJECTIVE
To evaluate the feasibility of percutaneous access via the recanalized paraumbilical vein for varix embolization.
MATERIALS AND METHODS
Between July 2008 and Jan 2014, percutaneous access via the recanalized paraumbilical vein for varix embolization was attempted in seven patients with variceal bleeding. Paraumbilical vein puncture was performed under ultrasonographic guidance, followed by introduction of a 5-Fr sheath. We retrospectively evaluated the technical feasibility, procedure-related complications, and clinical outcomes of each patient.
RESULTS
Recanalized paraumbilical vein catheterization was performed successfully in all patients. Gastroesophageal varix embolization was performed in six patients, and umbilical varix embolization was performed in one patient. Embolic materials used are N-butyl cyanoacrylate (n = 6) and coil with N-butyl cyanoacrylate (n = 1). There were no procedure-related complications. One patient underwent repeated variceal embolization 6 hours after initial procedure via recanalized paraumbilical vein, due to rebleeding from gastric varix.
CONCLUSION
Percutaneous access via the paraumbilical vein for varix embolization is a simple alternative in patients with portal hypertension.

Keyword

Paraumbilical vein; Varix; Embolization

MeSH Terms

Adult
Child
Embolization, Therapeutic
Enbucrilate/therapeutic use
Esophageal and Gastric Varices/radiography/*therapy
Female
Humans
Intracranial Hemorrhages/etiology
Male
Middle Aged
Retrospective Studies
Tomography, X-Ray Computed
Treatment Outcome
Umbilical Veins/surgery/ultrasonography
Enbucrilate

Figure

  • Fig. 1 52-year-old man presented with melena. A. Transverse CT scan shows tumor thrombus in right portal vein (black arrowhead), gastric varix (white arrowhead), and recanalized paraumbilical vein (arrow). B. Maximum intensity projection image of left anterior oblique view shows gastroesophageal varix (arrowhead) and recanalized paraumbilical vein (arrow). C. Splenic venography shows gastroesophageal varix (white arrowhead) and filling defect caused by tumor thrombus (black arrowhead). Note that catheter was advanced via paraumbilical vein (arrow). D. Splenic venography after variceal embolization shows subtraction artifact (arrowhead) caused by embolic materials (coils and mixture of N-butyl cyanoacrylate and iodized oil) in gastric varix.

  • Fig. 2 49-year-old man presented with melena. A. Transverse CT scan shows extravasation of contrast media (arrow) and blood clot (star) within stomach. B. Transverse CT scan shows recanalized paraumbilical vein (arrowhead). C. Left gastric venography shows gastroesophageal varix (arrowhead). D. Splenic venography after variceal embolization shows subtraction artifact (arrowhead) caused by embolic materials (mixture of N-butyl cyanoacrylate and iodized oil).

  • Fig. 3 11-year-old boy presented with umbilical varix bleeding. A. Volume-rendering image of CT scan shows recanalized paraumbilical vein (arrowhead), umbilical varix (arrow), and draining systemic veins (open arrowheads). B. Spot image after embolization shows embolic materials within umbilical varix (arrow) and 5-Fr sheath (arrowhead) which was inserted in paraumbilical vein.


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