CardioVascular and Interventional Radiology

, Volume 28, Issue 2, pp 178–184

Ectopic Varices in the Gastrointestinal Tract: Short- and Long-Term Outcomes of Percutaneous Therapy

  • Thanila A. Macedo
  • James C. Andrews
  • Patrick S. Kamath
Clinical Investigation

DOI: 10.1007/s00270-004-0148-8

Cite this article as:
Macedo, T.A., Andrews, J.C. & Kamath, P.S. Cardiovasc Intervent Radiol (2005) 28: 178. doi:10.1007/s00270-004-0148-8
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Abstract

To evaluate the results of percutaneous management of ectopic varices, a retrospective review was carried out of 14 patients (9 men, 5 women; mean age 58 years) who between 1992 and 2001 underwent interventional radiological techniques for management of bleeding ectopic varices. A history of prior abdominal surgery was present in 12 of 14 patients. The interval between the surgery and percutaneous intervention ranged from 2 to 38 years. Transhepatic portal venography confirmed ectopic varices to be the source of portal hypertension-related gastrointestinal bleeding. Embolization of the ectopic varices was performed by a transhepatic approach with coil embolization of the veins draining into the ectopic varices. Transjugular intrahepatic portosystemic shunt (TIPS) was performed in the standard fashion. Eighteen procedures (12 primary coil embolizations, 1 primary TIPS, 2 re-embolizations, 3 secondary TIPS) were performed in 13 patients. One patient was not a candidate for percutaneous treatment. All interventions but one (re-embolization) were technically successful. In 2 of 18 interventions, re-bleeding occurred within 72 hr (both embolization patients). Recurrent bleeding (23 days to 27 months after initial intervention) was identified in 9 procedures (8 coil embolizations, 1 TIPS due to biliary fistula). One patient had TIPS revision because of ultrasound surveillance findings. New encephalopathy developed in 2 of 4 TIPS patients. Percutaneous coil embolization is a simple and safe treatment for bleeding ectopic varices; however, recurrent bleeding is frequent and reintervention often required. TIPS can offer good control of bleeding at the expense of a more complex procedure and associated risk of encephalopathy.

Keywords

Ectopic varices Percutaneous therapy Portal hypertension 

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Thanila A. Macedo
    • 1
  • James C. Andrews
    • 1
  • Patrick S. Kamath
    • 2
  1. 1.Department of RadiologyMayo Clinic and FoundationRochesterUSA
  2. 2.Division of Gastroenterology and HepatologyMayo Clinic and FoundationRochesterUSA

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