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Deliwala SS, Hussain M, Ponnapalli A, Igbinedion SO, Bachuwa G, Bansal A. Accelerated balloon-retrograde transvenous obliteration (BRTO): an effective tool in the Arsenal against isolated gastric varices (IGV). BMJ Case Rep 2021; 14:e244405. [PMID: 34489255 PMCID: PMC8422294 DOI: 10.1136/bcr-2021-244405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 12/20/2022] Open
Abstract
Gastric and oesophageal variceal bleeding poses high morbidity and mortality in cirrhosis. Amongst all types, isolated gastric varices (IGV) carry the highest propensity to bleed. Successful outcomes combine endoscopic and interventional radiology approaches using ligation, coils, glue or sclerosants. Transjugular intrahepatic portosystemic shunt success is only seen in a subset of patients, while balloon-retrograde transvenous obliteration (BRTO) has demonstrated high efficacy in preventing rebleeding and morbidity in patients with a myriad of anatomies and shunts. The American Association for the Study of Liver disease guidelines do not favour any particular modality; however, recent trials and meta-analyses support BRTO as the first-line therapy. Despite promising results, BRTO adoption is limited by procedural time, patient length-of-stay and equipment compatibilities hindering scalability in academic and community settings. To address these concerns, we present a successfully treated case of IGV with a revised technique called accelerated BRTO.
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Affiliation(s)
| | - Murtaza Hussain
- Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | | | - Samuel O Igbinedion
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Ghassan Bachuwa
- Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Anish Bansal
- Department of Interventional Radiology, Michigan State University at Hurley Medical Center, Flint, Michigan, USA
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Waguri N, Osaki A, Watanabe Y. Balloon-occluded retrograde transvenous obliteration for treatment of gastric varices. World J Hepatol 2021; 13:650-661. [PMID: 34239700 PMCID: PMC8239489 DOI: 10.4254/wjh.v13.i6.650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/12/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023] Open
Abstract
Rupture of gastric varices (GVs) can be fatal. Balloon-occluded retrograde transvenous obliteration (BRTO), as known as retrograde sclerotherapy, has been widely adopted for treatment of GVs because of its effectiveness, ability to cure, and utility in emergency and prophylactic treatment. Simplifying the route of blood flow from GVs to the gastrorenal shunt is important for the successful BRTO. This review outlines BRTO indications and contraindications, describes basic BRTO procedures and modifications, compares BRTO with other GVs treatments, and discusses various combination therapies. Combined BRTO and partial splenic embolization may prevent exacerbation of esophageal varices and shows promise as a treatment option.
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Affiliation(s)
- Nobuo Waguri
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata 950-1197, Japan
| | - Akihiko Osaki
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata 950-1197, Japan
| | - Yusuke Watanabe
- Department of Gastroenterology and Hepatology, Niigata City General Hospital, Niigata 950-1197, Japan
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Abstract
OBJECTIVE. The left inferior phrenic vein (LIPV) can be an origin of a gastrorenal shunt from gastric varices. The purpose of our study was to evaluate the angiographic anatomy of the LIPV, particularly anastomoses of the LIPV with the portal vein (PV). SUBJECTS AND METHODS. Of 240 patients with primary aldosteronism who underwent adrenal venous sampling from April 2011 to July 2019, 236 had normal liver and renal function and were included in this study. Of those patients, 214 had evaluable LIPV venography. The angiographic anatomy of the LIPV was classified as type 1 when the subdiaphragmatic transverse part of the LIPV could be visualized or as type 2 when it could not. Type 1 was subclassified into type 1a, which was defined as the transverse part of the LIPV connected with a single vein, or type 1b, which was defined as the transverse part of the LIPV connected with several veins via anastomoses. Type 2 LIPVs were subclassified into type 2a, in which the LIPV had an undeveloped vertical part; type 2b, in which the LIPV had backflow into systemic veins; or type 2c, in which the LIPV had a connection to the PV. The presence of an anastomosis with the PV was defined as the PV being visualizable on LIPV venography. RESULTS. Assessment of LIPV venography revealed type 1 in 71.5% (153/214) of patients, including type 1a (22.4%, 48/214) and type 1b (49.1%, 105/214). Type 2 LIPVs were observed in 28.5% (61/214) of patients, including types 2a (6.5%, 14/214), 2b (11.2%, 24/214), and 2c (10.7%, 23/214). An anastomosis of the LIPV with the PV was found in 28.0% (60/214) of patients, including 10.7% (23/214) with type 2c and 17.3% (37/214) with type 1 with a visible PV. The anastomoses of the LIPV with the PV were of various sizes. CONCLUSION. The angiographic anatomy of the LIPV varied and was commonly formed from several veins connected by anastomoses. An anastomosis between the LIPV and PV, which might be the origin of gastric varices, was found in 28.0% of patients.
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Hirota S, Kobayashi K, Kako Y, Takaki H, Yamakado K. Balloon-occluded retrograde transvenous obliteration of varices: focusing on the portal hemodynamics and the recent techniques. Hepatol Int 2017; 12:102-111. [PMID: 28875380 DOI: 10.1007/s12072-017-9813-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/25/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the recent topics of Ballloon-occluded retrograde trasnvenous obliteration(B-RTO). METHOD We overviewed the recent scientific papers regarding B-RTO. RESULT B-RTO is a treatment method for occluding varices retrogradely using a sclerosing agent under balloon occlusion of a major draining vein. It has been recognized as an effective treatment method for gastric varices. Hepatic function reserve is improved and liver volume is increased after B-RTO. In recent years, various technical options, such as plug-assisted retrograde transvenous obliteration, coil-assisted retrograde transvenous obliteration, or foam B-RTO, have also been reported. In performing B-RTO, portal hemodynamics must be thoroughly examined radiologically. Judging the classification of the grade of collateral venous hemodynamics is important to select the appropriate embolization technique of B-RTO and to successfully occlude varices. Finally, the word "portosystemic shunt syndrome" has been proposed and the condition should be considered while selecting a treatment for gastric varices. CONCLUSION B-RTO is effective for gastrointestinal varices and portosystemic shunts.
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Affiliation(s)
- Shozo Hirota
- Department of Radiology, Hyogo College of Medicine, Mukogawacho 1-1, Nishinomiya, Japan.
| | - Kaoru Kobayashi
- Department of Radiology, Hyogo College of Medicine, Mukogawacho 1-1, Nishinomiya, Japan
| | - Yasukazu Kako
- Department of Radiology, Hyogo College of Medicine, Mukogawacho 1-1, Nishinomiya, Japan
| | - Haruyuki Takaki
- Department of Radiology, Hyogo College of Medicine, Mukogawacho 1-1, Nishinomiya, Japan
| | - Koichiro Yamakado
- Department of Radiology, Hyogo College of Medicine, Mukogawacho 1-1, Nishinomiya, Japan
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Kariya S, Komemushi A, Nakatani M, Yoshida R, Kono Y, Shiraishi T, Tanigawa N. Portopulmonary venous anastomosis in balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices. J Gastroenterol Hepatol 2014; 29:1522-7. [PMID: 24650189 DOI: 10.1111/jgh.12583] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIM Several reports have described portopulmonary venous anastomosis (PPVA). However, in balloon-occluded retrograde transvenous obliteration (BRTO), attention has not been paid to paradoxical embolism. The objective of this study was to investigate the existence of a right-left shunt due to PPVA when the drainage vein is occluded by a balloon during BRTO. METHODS The subjects were 19 patients who underwent BRTO. Whether PPVA was present was confirmed on balloon-occluded retrograde transvenous venography (BRTV). After BRTV, a retrograde bolus injection of 20 mL of carbon dioxide (CO2 ) via the balloon catheter was performed under balloon occlusion, and the flow of bubbles into both ventricles was observed with four-chamber view echocardiography. During the same balloon occlusion, bolus injection of CO2 into the inferior vena cava was performed, followed by echocardiography. RESULTS PPVA was confirmed on BRTV in four patients (21.1%). On echocardiography with retrograde CO2 injection, bubbles were confirmed in the left ventricle in six patients (31.6%). On echocardiography with CO2 injection into the inferior vena cava, bubbles were not confirmed in the left ventricle in any cases. CONCLUSIONS When the draining vein was occluded with a balloon and blood flow in a gastrorenal or gastrocaval shunt was stopped during BRTO, PPVA was confirmed in 21.1% of cases on retrograde angiography, and a right-left shunt was confirmed in 31.6% of cases on echocardiography.
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Affiliation(s)
- Shuji Kariya
- Department of Radiology, Kansai Medical University, Hirakata, Osaka, Japan
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Cesmebasi A, Du Plessis M, Iannatuono M, Shah S, Tubbs RS, Loukas M. A review of the anatomy and clinical significance of adrenal veins. Clin Anat 2014; 27:1253-63. [PMID: 24737134 DOI: 10.1002/ca.22374] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 01/02/2014] [Indexed: 11/08/2022]
Abstract
The adrenal veins may present with a multitude of anatomical variants, which surgeons must be aware of when performing adrenalectomies. The adrenal veins originate during the formation of the prerenal inferior vena cava (IVC) and are remnants of the caudal portion of the subcardinal veins, cranial to the subcardinal sinus in the embryo. The many communications between the posterior cardinal, supracardinal, and subcardinal veins of the primordial venous system provide an explanation for the variable anatomy. Most commonly, one central vein drains each adrenal gland. The long left adrenal vein joins the inferior phrenic vein and drains into the left renal vein, while the short right adrenal vein drains immediately into the IVC. Multiple variations exist bilaterally and may pose the risk of surgical complications. Due to the potential for collaterals and accessory adrenal vessels, great caution must be taken during an adrenalectomy. Adrenal venous sampling, the gold standard in diagnosing primary hyperaldosteronism, also requires the clinician to have a thorough knowledge of the adrenal vein anatomy to avoid iatrogenic injury. The adrenal vein acts as an important conduit in portosystemic shunts, thus the nature of the anatomy and hypercoagulable states pose the risk of thrombosis.
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Affiliation(s)
- Alper Cesmebasi
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies
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Imai Y, Nakazawa M, Ando S, Sugawara K, Hamaoka K, Oka M, Mochida S. Balloon-occluded retrograde transvenous obliteration using a microballoon catheter for intractable gastric fundal varices. J Gastroenterol Hepatol 2014; 29:365-71. [PMID: 23927078 DOI: 10.1111/jgh.12351] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Balloon-occluded retrograde transvenous obliteration (B-RTO) is recognized as the standard therapy for patients with gastric fundal varices in Japan; however, the procedure is difficult when drainage veins other than the gastrorenal shunt developed. The efficacy and safety of B-RTO using a microballoon catheter for such patients were evaluated. METHODS The subjects were 99 patients with gastric fundal varices who fulfilled the criteria for receiving endoscopic and/or interventional therapies. Among these, 95 patients underwent B-RTO. Of the 95 patients, 14 were treated with the use of microballoon catheters, including nine in whom the left inferior phrenic vein was found as a secondary drainage vein in addition to the gastrorenal shunt, and five in whom a gastrorenal shunt was absent. The B-RTO procedure performed using a microballoon catheter inserted through the left inferior phrenic vein in 13 patients, and through the pericardiophrenic vein in one patient. RESULTS The B-RTO procedure using microballoon catheters was successful in 13 of the 14 patients (93%), while in the remaining one patient, multiple drainage veins were visualized on venography. Complete obliteration of the varices was achieved in all the 13 patients by injection of 5% ethanolamine oleate iopamidol at a median volume of 25 mL (range, 11 to 40 mL) through the catheters. None of the patients showed injuries of the drainage veins or any systemic complications. CONCLUSIONS B-RTO using a microballoon catheter is useful for the treatment of gastric fundal varices in which drainage veins other than the gastrorenal shunt developed.
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Affiliation(s)
- Yukinori Imai
- Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, Iruma-gun, Saitama, Japan
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Kirby JM, Cho KJ, Midia M. Image-guided Intervention in Management of Complications of Portal Hypertension: More than TIPS for Success. Radiographics 2013; 33:1473-96. [DOI: 10.1148/rg.335125166] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Balloon-occluded retrograde transvenous obliteration of gastric varices: use of CT-guided foam sclerotherapy to optimize technique. AJR Am J Roentgenol 2012; 199:200-7. [PMID: 22733913 DOI: 10.2214/ajr.11.7002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Balloon-occluded retrograde transvenous obliteration has been traditionally based on liquid sclerotherapy. However, overdose and systemic spillage of liquid sclerosant can cause severe complications, such as hemolysis, which lead to hemoglobinuria, allergy, acute respiratory distress syndrome, and other disorders. The purpose of this study was to evaluate the performance of foam sclerotherapy with C-arm CT guidance to reduce the amount of sclerosant and to optimize the safety of balloon-occluded retrograde transvenous obliteration while preserving its efficacy. MATERIALS AND METHODS Twenty consecutively registered patients with gastric varices underwent balloon-occluded retrograde transvenous obliteration with polidocanol foam. C-arm CT guidance was used to confirm gas filling of the target vessels. In this retrospective analysis of a prospectively encoded database, total net doses of polidocanol used for transvenous obliteration and of contrast medium used for venography before transvenous obliteration were compared, and subsequent complications, including hemoglobinuria, were documented. RESULTS In all patients, foam was observed in the target vessels at C-arm CT. The mean dose of polidocanol used for balloon-occluded retrograde transvenous obliteration (3.9 ± 1.5 mL) was significantly smaller (p < 0.001) than the dose of contrast medium used for venography (16.4 ± 7.9 mL). Hemoglobinuria was found in only one patient. Except in one instance of recanalization, full variceal thrombosis was confirmed at contrast-enhanced CT 1 week after transvenous obliteration (success rate, 95%). In one patient, air migrated into the liver during transvenous obliteration but was spontaneously absorbed. No serious complication occurred. CONCLUSION Balloon-occluded retrograde transvenous obliteration with polidocanol foam under C-arm CT guidance allowed significant reduction of sclerosant dose and resulted in a low complication rate while a high technical success rate and efficacy were maintained.
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Minamiguchi H, Kawai N, Sato M, Sawa M, Ikoma A, Sanda H, Nakata K, Nakai M, Sonomura T. Dual microcatheter retrograde transvenous obliteration of gastric varices: coil embolization as a substitute for balloon occlusion. Case Rep Gastroenterol 2012; 6:74-81. [PMID: 22423243 PMCID: PMC3304073 DOI: 10.1159/000336588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Dual microcatheter retrograde transvenous obliteration (DMRTO) of gastric varices enables dual microcatheters to be advanced to the gastric varices themselves or to a site adjacent to the varices. The sclerosing agent is infused through the first microcatheter following coil embolization of the outflow vessels through the second microcatheter, which is placed several centimeters back from the varices. We present two cases of gastric varices in whom balloon-occluded retrograde transvenous obliteration failed, because of angulated gastrosubphrenic shunt in case 1 and a tortuous and elongated gastrorenal shunt in case 2. DMRTO successfully achieved eradication of the gastric varices in both cases.
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Successful Balloon-Occluded Retrograde Transvenous Obliteration for Gastric Varix Mainly Draining into the Pericardiophrenic Vein. Cardiovasc Intervent Radiol 2011; 35:180-3. [DOI: 10.1007/s00270-011-0233-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 07/14/2011] [Indexed: 10/17/2022]
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Koizumi J, Hashimoto T, Myojin K, Fukushima T, Ichikawa T, Kagawa T, Kojima S, Watanabe N, Mine T, Nishibe T, Janne d'Othée B. C-arm CT-guided foam sclerotherapy for the treatment of gastric varices. J Vasc Interv Radiol 2011; 21:1583-7. [PMID: 20801674 DOI: 10.1016/j.jvir.2010.05.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 02/23/2010] [Accepted: 05/21/2010] [Indexed: 12/23/2022] Open
Abstract
The authors describe here the use of foam sclerotherapy under C-arm computed tomography (CT) guidance for the treatment of gastric varices via balloon-occluded retrograde transvenous obliteration in seven patients and percutaneous transhepatic obliteration in one patient. All gastric varices were occluded successfully after replacement of blood by foam, which was trapped in the gastric varices as shown by C-arm CT. It also helped reduce the amount of sclerosant, an issue that is associated with severe complications, such as hemolysis, allergy, acute respiratory distress syndrome, and others. Foam sclerotherapy under C-arm CT guidance is a promising tool in the therapeutic armamentarium against gastric varices.
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Affiliation(s)
- Jun Koizumi
- Department of Diagnostic Radiology, School of Medicine, Tokai University, 143 Shimokasuya, Isehara-city, Kanagawa-prefecture 259-1193, Japan.
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Matsumoto T, Yamagami T, Nakamura N, Kato T, Hirota T, Yoshimatsu R, Nishimura T. Balloon-occluded retrograde transvenous obliteration of a gastric varix via the left inferior phrenic vein. Br J Radiol 2008; 81:e246-8. [PMID: 18796552 DOI: 10.1259/bjr/19387136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
We encountered a patient with a gastric varix that drained through the left inferior phrenic vein, which directly entered the inferior vena cava at the point just inferior to the diaphragm. In this patient, gastrorenal shunt was not seen. Balloon-occluded retrograde transvenous obliteration of the gastric varix was performed, in which 50% glucose and 5% ethanolamine oleate-iopamidol were injected as sclerosing agents while the balloon was inflated in the left inferior phrenic vein. 1 week after the procedure, the disappearance of enhancement in the gastric varix was confirmed on contrast-enhanced multidetector row CT. Furthermore, a significant reduction in the size of the varix was confirmed on endoscopic examination 4 months later.
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Affiliation(s)
- T Matsumoto
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku 602-8566, Kyoto, Japan.
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Treatment of Hepatic Encephalopathy Due to Inferior Mesenteric Vein/Inferior Vena Cava and Gonadal Vein Shunt Using Dual Balloon-Occluded Retrograde Transvenous Obliteration. Cardiovasc Intervent Radiol 2008; 32:390-3. [DOI: 10.1007/s00270-008-9422-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2008] [Revised: 07/05/2008] [Accepted: 07/21/2008] [Indexed: 10/21/2022]
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Matake K, Tajima T, Yoshimitsu K, Irie H, Aibe H, Nishie A, Asayama Y, Honda H. Hepatic Encephalopathy from Dual Splenorenal Shunts Treated with Balloon-Occluded Retrograde Transvenous Obliteration by Using a Double-Balloon Technique. J Vasc Interv Radiol 2007; 18:1436-40. [DOI: 10.1016/j.jvir.2007.07.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Maeda H, Hirota S, Yamamoto S, Kobayashi K, Arai K, Miyamoto Y, Fukuda T, Sugimoto K, Nakao N. Radiologic Variations in Gastrorenal Shunts and Collateral Veins from Gastric Varices in Images Obtained Before Balloon-Occluded Retrograde Transvenous Obliteration. Cardiovasc Intervent Radiol 2007; 30:410-4. [PMID: 17278038 DOI: 10.1007/s00270-005-0362-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate variations in the features of gastrorenal shunts and collateral veins shown by balloon-occluded retrograde venography (B-RTV) and by superior mesenteric and celiac arteriography. METHODS A retrospective analysis was performed of the variation in these features on B-RTV and arteriography images obtained from 130 patients who have undergone these studies prior to balloon-occluded retrograde transvenous obliteration at our hospital since 1993. RESULTS At least one gastrorenal shunt was revealed in 97% (126/130) of cases. Types of gastrorenal shunts observed were as follows: only one main gastrorenal shunt, 94% (118/126) of cases; two main gastrorenal shunts with a ring-like appearance, 3% (4/126); and some gastrorenal shunts to the left renal vein, 3% (4/126). Collateral veins detected were as follows: left inferior phrenic vein, 75% (95/126) of cases; pericardiacophrenic vein, 40% (50/126); gonadal vein, 13% (16/126); retroperitoneal veins, 65% (82/126). CONCLUSION It is very important to know the exact configuration of any gastrorenal shunts in order to guide advancement of the balloon catheter into the shunt and to avoid unexpected injection of the sclerosing agent.
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Affiliation(s)
- Hiroaki Maeda
- Department of Radiology, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
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Nishida N, Ninoi T, Kitayama T, Tokunaga M, Sakai Y, Hamuro M, Nakamura K, Inoue Y, Yamada R. Selective balloon-occluded retrograde transvenous obliteration of gastric varix with preservation of major portacaval shunt. AJR Am J Roentgenol 2006; 186:1155-7. [PMID: 16554596 DOI: 10.2214/ajr.04.1971] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Norifumi Nishida
- Department of Radiology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-bu, Osaka, Japan 545-8585.
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