Advertisement

Hepatology International

, Volume 7, Issue 1, pp 241–247 | Cite as

Short- and long-term clinical outcome after balloon-occluded retrograde transvenous obliteration: is pretreatment portal flow direction a predictive factor?

  • Hidehiro Kamezaki
  • Hitoshi MaruyamaEmail author
  • Taro Shimada
  • Masanori Takahashi
  • Hidehiro Okugawa
  • Osamu Yokosuka
Original Article

Abstract

Purpose

To determine whether pretreatment portal flow direction can predict different clinical manifestations or prognosis after balloon-occluded retrograde transvenous obliteration (B-RTO) for gastric varices.

Methods

The subjects were 103 cirrhotic patients with medium- or large-grade gastric varices treated by B-RTO. Short- and long-term clinical outcomes were compared among patients with forward portal flow (F group) and those with reversed or to-and-fro portal flow (R group) on color Doppler sonography before B-RTO.

Results

Deterioration of liver function reserve 1 year after B-RTO was more frequent in the R group (34.7 %) than in the F group (11.1 %, p = 0.0251). Thrombotic disorders within 1 year after B-RTO were also more frequent in the R group (20.7 %) than in the F group (2.7 %, p = 0.0079). There was no significant difference in cumulative survival rate of Child class A patients between the two groups. In Child class B or class C patients, however, the cumulative survival rate was poorer in the R group (68.7, 30.5, and 30.5 % at 1, 5, and 9 years, respectively) than in the F group (94.9, 58.8, and 37.8 % and 1, 5, and 9 years, respectively; p = 0.0097).

Conclusions

Hemodynamic assessment of portal flow direction is important before B-RTO, and care should be taken to manage thrombotic disorders in the perioperative period in patients with reversed portal flow after B-RTO. Another treatment option might be preferred for gastric varices in Child classes B and C patients with reversed portal flow instead of B-RTO, which may have a poor prognosis.

Keywords

Balloon-occluded retrograde transvenous obliteration (B-RTO) Doppler ultrasound Gastric varices Portal hypertension 

References

  1. 1.
    Kim T, Shijo H, Kokawa H, et al. Risk factors for hemorrhage from gastric fundal varices. Hepatology 1997;25:307–312PubMedCrossRefGoogle Scholar
  2. 2.
    Trudeau W, Prindiville T. Endoscopic injection sclerosis in bleeding gastric varices. Gastrointest Endosc 1986;32:264–268PubMedCrossRefGoogle Scholar
  3. 3.
    Sarin SK, Sachdev G, Nanda R, et al. Endoscopic sclerotherapy in the treatment of gastric varices. Br J Surg 1988;75:747–750PubMedCrossRefGoogle Scholar
  4. 4.
    Sarin SK, Lahoti D, Saxena SP, et al. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology 1992;16:1343–1349PubMedCrossRefGoogle Scholar
  5. 5.
    Akiyoshi N, Shijo H, Iida T, et al. The natural history and prognostic factors in patients with cirrhosis and gastric fundal varices without prior bleeding. Hepatol Res 2000;17:145–155PubMedCrossRefGoogle Scholar
  6. 6.
    Kimura K, Ohto M, Matsutani S, et al. Relative frequencies of portosystemic pathways and renal shunt formation through the “posterior” gastric vein: portographic study in 460 patients. Hepatology 1990;12:725–728PubMedCrossRefGoogle Scholar
  7. 7.
    Kanagawa H, Mima S, Kouyama H, et al. Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol 1996;11:51–58PubMedCrossRefGoogle Scholar
  8. 8.
    Koito K, Namieno T, Nagakawa T, et al. Balloon-occluded retrograde transvenous obliteration for gastric varices with gastrorenal or gastrocaval collaterals. AJR Am J Roentgenol 1996;167:1317–1320PubMedCrossRefGoogle Scholar
  9. 9.
    Hirota S, Matsumoto S, Tomita M, et al. Retrograde transvenous obliteration of gastric varices. Radiology 1999;211:349–356PubMedGoogle Scholar
  10. 10.
    Chikamori F, Kuniyoshi N, Shibuya S, et al. Eight years of experience with transjugular retrograde obliteration for gastric varices with gastrorenal shunts. Surgery 2001;129:414–420PubMedGoogle Scholar
  11. 11.
    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;184:1340–1346PubMedCrossRefGoogle Scholar
  12. 12.
    Hiraga N, Aikata H, Takaki S, et al. The long-term outcome of patients with bleeding gastric varices after balloon-occluded retrograde transvenous obliteration. J Gastroenterol 2007;42:663–672PubMedCrossRefGoogle Scholar
  13. 13.
    Maruyama H, Okugawa H, Kobayashi S, et al. Pre-treatment hemodynamic features involved with long-term survival of cirrhotic patients after embolization of gastric fundal varices. Eur J Radiol 2010;75:e32–e37PubMedCrossRefGoogle Scholar
  14. 14.
    Maruyama H, Ishihara T, Ishii H, et al. Blood flow parameters in the short gastric vein and splenic vein on Doppler ultrasound reflect gastric variceal bleeding. Eur J Radiol 2010;75:e41–e45PubMedCrossRefGoogle Scholar
  15. 15.
    Okugawa H, Maruyama H, Kobayashi S, et al. Therapeutic effect of balloon-occluded retrograde transvenous obliteration for gastric varices in relation to haemodynamics in the short gastric vein. Br J Radiol 2009;82:930–935PubMedCrossRefGoogle Scholar
  16. 16.
    Tajiri T, Yoshida H, Obara K, et al. General rules for recording endoscopic findings of esophagogastric varices (2nd edition). Dig Endosc 2010;22:1–9PubMedCrossRefGoogle Scholar
  17. 17.
    Groszmann RJ, Glickman M, Blei AT, et al. Wedged and free hepatic venous pressure measured with a balloon catheter. Gastroenterology 1979;76:253–258PubMedGoogle Scholar
  18. 18.
    Barth KH, Udoff EJ. Transfemoral balloon catheterization for hepatic wedge pressure measurements. Radiology 1980;135:779–780PubMedGoogle Scholar
  19. 19.
    Shimoda R, Horiuchi K, Hagiwara S, et al. Short-term complications of retrograde transvenous obliteration of gastric varices in patients with portal hypertension: effects of obliteration of major portosystemic shunts. Abdom Imaging 2005;30:306–313PubMedCrossRefGoogle Scholar
  20. 20.
    Kumar DR, Hanlin E, Glurich I, et al. Virchow’s contribution to the understanding of thrombosis and cellular biology. Clin Med Res 2010;8:168–172PubMedCrossRefGoogle Scholar

Copyright information

© Asian Pacific Association for the Study of the Liver 2012

Authors and Affiliations

  • Hidehiro Kamezaki
    • 1
  • Hitoshi Maruyama
    • 1
    Email author
  • Taro Shimada
    • 1
  • Masanori Takahashi
    • 1
  • Hidehiro Okugawa
    • 1
  • Osamu Yokosuka
    • 1
  1. 1.Department of Medicine and Clinical Oncology, Graduate School of MedicineChiba UniversityChibaJapan

Personalised recommendations