Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0041-1723061
The Promise of Percutaneous Transhepatic Variceal Embolization for Both Gastroesophageal and Ectopic Varices—An Australian Case Series
![](https://www.thieme-connect.de/media/10.1055-s-00033348/202101/lookinside/thumbnails/10-1055-s-0041-1723061_00021-1.jpg)
Abstract
Purpose This article aims to report Australian experience of percutaneous transhepatic embolization of gastroesophageal and ectopic varices.
Method Eight consecutive patients (mean age 61.8 years, 7 men) who had undergone percutaneous transhepatic variceal embolization (PTVE) for variceal bleeding between October 2013 and February 2020 were analyzed. All patients were admitted from the emergency department. The following embolic materials were used—coils, Onyx 18 (Medtronic), and n-butyl cyanoacrylate plus lipiodol.
Results Post-PTVE, all eight patients demonstrated clinical and radiological improvement in the immediate postprocedure period (< 24 hours). Patients were followed for a mean of 44 ± 24 days postprocedure. Two patients were lost to follow-up. The postprocedure complications included rebleeding (n = 1), hepatic encephalopathy (n = 1), hemoperitoneum (n = 1), ileus (n = 1), and abdominal pain (n = 3).
Conclusion PTVE is an effective treatment option for patients with uncontrolled variceal bleeding (ectopic as well as gastroesophageal) especially when the traditional therapies such as transjugular intrahepatic portosystemic shunts, endoscopic variceal ligation, and balloon-occluded retrograde transvenous obliteration are contraindicated or ineffective.
Publication History
Article published online:
25 January 2021
© 2021. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Pagliaro L, D’Amico G, Pasta L. et al. Portal hypertension in cirrhosis: natural history. In: Bosch J, Groszmann RJ, eds. Portal Hypertension: Pathophysiology and Treatment. Oxford, United Kingdom: Blackwell Scientific Publications 1994
- 2 García-Pagán JC, Caca K, Bureau C. et al. Early TIPS (Transjugular Intrahepatic Portosystemic Shunt) Cooperative Study Group. Early use of TIPS in patients with cirrhosis and variceal bleeding. N Engl J Med 2010; 362 (25) 2370-2379
- 3 Graham DY, Smith JL. The course of patients after variceal hemorrhage. Gastroenterology 1981; 80 (04) 800-809
- 4 Garcia-Tsao G. Current management of the complications of cirrhosis and portal hypertension: variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterology 2001; 120 (03) 726-748
- 5 Bosch J, Abraldes JG, Groszmann R. Current management of portal hypertension. J Hepatol 2003; 38 (Suppl. 01) S54-S68
- 6 Burroughs AK, Vangeli M. Transjugular intrahepatic portosystemic shunt versus endoscopic therapy: randomized trials for secondary prophylaxis of variceal bleeding: an updated meta-analysis. Scand J Gastroenterol 2002; 37 (03) 249-252
- 7 Papatheodoridis GV, Goulis J, Leandro G, Patch D, Burroughs AK. Transjugular intrahepatic portosystemic shunt compared with endoscopic treatment for prevention of variceal rebleeding: a meta-analysis. Hepatology 1999; 30 (03) 612-622
- 8 Luca A, D’Amico G, La Galla R, Midiri M, Morabito A, Pagliaro L. TIPS for prevention of recurrent bleeding in patients with cirrhosis: meta-analysis of randomized clinical trials. Radiology 1999; 212 (02) 411-421
- 9 Pomier-Layrargues G, Villeneuve JP, Deschênes M. et al. Transjugular intrahepatic portosystemic shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in patients with cirrhosis: a randomised trial. Gut 2001; 48 (03) 390-396
- 10 Kanagawa H, Mima S, Kouyama H, Gotoh K, Uchida T, Okuda K. Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol 1996; 11 (01) 51-58
- 11 Kwak HS, Han YM. Percutaneous transportal sclerotherapy with N-butyl-2-cyanoacrylate for gastric varices: technique and clinical efficacy. Korean J Radiol 2008; 9 (06) 526-533
- 12 Kiyosue H, Matsumoto S, Yamada Y. et al. Transportal intravariceal sclerotherapy with N-butyl-2-cyanoacrylate for gastric varices. J Vasc Interv Radiol 2004; 15 (05) 505-509
- 13 Lunderquist A, Vang J. Transhepatic catheterization and obliteration of the coronary vein in patients with portal hypertension and esophageal varices. N Engl J Med 1974; 291 (13) 646-649
- 14 Smith-Laing G, Scott J, Long RG, Dick R, Sherlock S. Role of percutaneous transhepatic obliteration of varices in the management of hemorrhage from gastroesophageal varices. Gastroenterology 1981; 80 (5 pt 1) 1031-1036
- 15 Lunderquist A, Börjesson B, Owman T, Bengmark S. Isobutyl 2-cyanoacrylate (bucrylate) in obliteration of gastric coronary vein and esophageal varices. AJR Am J Roentgenol 1978; 130 (01) 1-6
- 16 Benner KG, Keeffe EB, Keller FS, Rösch J. Clinical outcome after percutaneous transhepatic obliteration of esophageal varices. Gastroenterology 1983; 85 (01) 146-153
- 17 Bengmark S, Börjesson B, Hoevels J, Joelsson B, Lunderquist A, Owman T. Obliteration of esophageal varices by PTP: a follow-up of 43 patients. Ann Surg 1979; 190 (04) 549-554
- 18 L’Herminé C, Chastanet P, Delemazure O, Bonnière PL, Durieu JP, Paris JC. Percutaneous transhepatic embolization of gastroesophageal varices: results in 400 patients. AJR Am J Roentgenol 1989; 152 (04) 755-760
- 19 Toumeh KK, Girardot JD, Choo IW, Andrews JC, Cho KJ. Percutaneous transhepatic embolization as treatment for bleeding ileostomy varices. Cardiovasc Intervent Radiol 1995; 18 (03) 179-182
- 20 Wang J, Tian XG, Li Y. et al. Comparison of modified percutaneous transhepatic variceal embolization and endoscopic cyanoacrylate injection for gastric variceal rebleeding. World J Gastroenterol 2013; 19 (05) 706-714
- 21 Sun A, Shi YJ, Xu ZD. et al. MDCT angiography to evaluate the therapeutic effect of PTVE for esophageal varices. World J Gastroenterol 2013; 19 (10) 1563-1571
- 22 Bian S, Tian XG, Hu JH, Wang GC, Zhang CQ. Percutaneous transhepatic variceal embolization combined with endoscopic ligation for the prevention of variceal rebleeding. J Dig Dis 2013; 14 (07) 388-395
- 23 Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology 1992; 16 (06) 1343-1349
- 24 Ryan BM, Stockbrugger RW, Ryan JM. A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices. Gastroenterology 2004; 126 (04) 1175-1189
- 25 Sabri SS, Swee W, Turba UC. et al. Bleeding gastric varices obliteration with balloon-occluded retrograde transvenous obliteration using sodium tetradecyl sulfate foam. J Vasc Interv Radiol 2011; 22 (03) 309-316, quiz 316
- 26 Jalan R, Hayes PC. British Society of Gastroenterology. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut 2000; 46 (Suppl 3-4) III1-III15
- 27 Chang MY, Kim MD, Kim T. et al. Plug-assisted retrograde transvenous obliteration for the treatment of gastric variceal Hemorrhage. Korean J Radiol 2016; 17 (02) 230-238
- 28 Gwon DI, Kim YH, Ko GY. et al. Vascular plug-assisted retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy: a prospective multicenter study. J Vasc Interv Radiol 2015; 26 (11) 1589-1595
- 29 Cho SK, Shin SW, Lee IH. et al. Balloon-occluded retrograde transvenous obliteration of gastric varices: outcomes and complications in 49 patients. AJR Am J Roentgenol 2007; 189 (06) W365-W372
- 30 Ninoi T, Nishida N, Kaminou T. et al. Balloon-occluded retrograde transvenous obliteration of gastric varices with gastrorenal shunt: long-term follow-up in 78 patients. AJR Am J Roentgenol 2005; 184 (04) 1340-1346
- 31 Tsurusaki M, Sugimoto K, Matsumoto S. et al. Bleeding duodenal varices successfully treated with balloon-occluded retrograde transvenous obliteration (B-RTO) assisted by CT during arterial portography. Cardiovasc Intervent Radiol 2006; 29 (06) 1148-1151
- 32 Zamora CA, Sugimoto K, Tsurusaki M. et al. Endovascular obliteration of bleeding duodenal varices in patients with liver cirrhosis. Eur Radiol 2006; 16 (01) 73-79
- 33 Hashimoto N, Akahoshi T, Yoshida D. et al. The efficacy of balloon-occluded retrograde transvenous obliteration on small intestinal variceal bleeding. Surgery 2010; 148 (01) 145-150
- 34 Hayashi S, Baba Y, Senokuchi T, Ueno K, Nakajo M. Successful portal-systemic shunt occlusion of a direct shunt between the inferior mesenteric vein and inferior vena cava with balloon-occluded retrograde transvenous obliteration following recanalization after placing a covered stent in the portal and superior mesenteric veins. Jpn J Radiol 2009; 27 (04) 180-184
- 35 Minami S, Okada K, Matsuo M, Kamohara Y, Sakamoto I, Kanematsu T. Treatment of bleeding stomal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol 2007; 42 (01) 91-95
- 36 Minamiguchi H, Kawai N, Sato M. et al. Balloon occlusion retrograde transvenous obliteration for inferior mesenteric vein-systemic shunt. J Vasc Interv Radiol 2011; 22 (07) 1039-1044
- 37 Zhang CQ, Liu FL, Liang B. et al. A modified percutaneous transhepatic variceal embolization with 2-octyl cyanoacrylate versus endoscopic ligation in esophageal variceal bleeding management: randomized controlled trial. Dig Dis Sci 2008; 53 (08) 2258-2267
- 38 Tian X, Shi Y, Hu J, Wang G, Zhang C. Percutaneous transhepatic variceal embolization with cyanoacrylate vs. transjugular intrahepatic portal systematic shunt for esophageal variceal bleeding. Hepatol Int 2013; 7 (02) 636-644
- 39 Loffroy RF, Abualsaud BA, Lin MD, Rao PP. Recent advances in endovascular techniques for management of acute nonvariceal upper gastrointestinal bleeding. World J Gastrointest Surg 2011; 3 (07) 89-100
- 40 Lenhart M, Paetzel C, Sackmann M. et al. Superselective arterial embolisation with a liquid polyvinyl alcohol copolymer in patients with acute gastrointestinal haemorrhage. Eur Radiol 2010; 20 (08) 1994-1999