European Radiology

, Volume 16, Issue 1, pp 73–79

Endovascular obliteration of bleeding duodenal varices in patients with liver cirrhosis

  • Carlos Armando Zamora
  • Koji Sugimoto
  • Masakatsu Tsurusaki
  • Kenta Izaki
  • Tetsuya Fukuda
  • Shinichi Matsumoto
  • Yoichiro Kuwata
  • Ryota Kawasaki
  • Takanori Taniguchi
  • Shozo Hirota
  • Kazuro Sugimura
Gastrointestinal

DOI: 10.1007/s00330-005-2781-2

Cite this article as:
Zamora, C.A., Sugimoto, K., Tsurusaki, M. et al. Eur Radiol (2006) 16: 73. doi:10.1007/s00330-005-2781-2

Abstract

The purpose of this paper is to describe our experience with endovascular obliteration of duodenal varices in patients with liver cirrhosis and portal hypertension. Balloon-occluded transvenous retrograde and percutaneous transhepatic anterograde embolizations were performed for duodenal varices in five patients with liver cirrhosis, portal hypertension, and decreased liver function. All patients had undergone previous endoscopic treatments that failed to stop bleeding and were poor surgical candidates. Temporary balloon occlusion catheters were used to achieve accumulation of an ethanolamine oleate–iopamidol mixture inside the varices. Elimination of the varices was successful in all patients. Retrograde transvenous obliteration via efferent veins to the inferior vena cava was enough to achieve adequate sclerosant accumulation in three patients. A combined anterograde–retrograde embolization was used in one patient with balloon occlusion of afferent and efferent veins. Transhepatic embolization through the afferent vein was performed in one patient under balloon occlusion of both efferent and afferent veins. There was complete variceal thrombosis and no bleeding was observed at follow-up. No major complications were recorded. Endovascular obliteration of duodenal varices is a feasible and safe alternative procedure for managing patients with portal hypertension and hemorrhage from this source.

Keywords

Portal hypertension Duodenal hemorrhage Varices Interventional procedures 

Abbreviations

ASPDV

Anterior superior pancreaticoduodenal vein

BRTO

Balloon-occluded retrograde transvenous obliteration

CECT

Contrast-enhanced computed tomography

EGD

Esophagogastroduodenoscopy

IPDV

Inferior pancreaticoduodenal vein

IVC

Inferior vena cava

PSPDV

Posterior superior pancreaticoduodenal vein

PTO

Percutaneous transhepatic obliteration

TIPS

Transjugular intrahepatic portosystemic shunt

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Carlos Armando Zamora
    • 1
  • Koji Sugimoto
    • 1
  • Masakatsu Tsurusaki
    • 1
  • Kenta Izaki
    • 1
  • Tetsuya Fukuda
    • 1
  • Shinichi Matsumoto
    • 1
  • Yoichiro Kuwata
    • 2
  • Ryota Kawasaki
    • 1
  • Takanori Taniguchi
    • 1
  • Shozo Hirota
    • 3
  • Kazuro Sugimura
    • 1
  1. 1.Department of RadiologyKobe University School of MedicineKobe-shi, Hyogo-kenJapan
  2. 2.Department of RadiologyNishi-Kobe Medical CenterKobe-shi, Hyogo-kenJapan
  3. 3.Department of RadiologyHyogo Medical CollegeNishinomiya-shi, Hyogo-kenJapan

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