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Management of Gastric Varices in the Pediatric Population with Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) Utilizing Sodium Tetradecyl Sulfate Foam Sclerosis with or without Partial Splenic Artery Embolization

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Abstract

It is unknown whether spontaneous gastrorenal shunts actually develop in the pediatric population. The minimum age documented in studies from Asia is 32 (range 32–44) years. This study describes three pediatric patients undergoing balloon-occluded retrograde transvenous obliteration (BRTO) for bleeding gastric varices with two of the three patients undergoing combined partial splenic embolization. The first BRTO is a selective-BRTO via a surgical splenorenal shunt (15 years old) and the other two patients underwent conventional-BRTO via a spontaneous gastrorenal shunt (8 and 14 years old). The recurrent significant bleeding that they exhibited before the combined endovascular therapy did not recur for an average of 7.1 (range 1.4–14) months. In the second patient, quantitative digitally subtracted angiography was utilized to evaluate the inline portal venous flow before and after BRTO.

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Conflict of interest

None of the authors have declared a conflict of interest.

Disclosures

Saad, Angle, and Matsumoto are consultants and grant recipients from Siemens, Germany (this is a conflict of interest with the i-Flow QDSA).

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Authors and Affiliations

  1. Department of Radiology, Division of Vascular Interventional Radiology, University of Virginia Health System, 1215 Lee Street, PO Box 800170, Charlottesville, VA, 22908, USA

    Wael E. A. Saad, Curtis L. Anderson, Sandra Schwaner, Shawn Pelletier, John Angle & Alan H. Matsumoto

  2. Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1428 Madison Avenue, New York, NY, 10029, USA

    Rahul S. Patel & Aaron M. Fischman

  3. Department of Medicine, Division of Gastroenterology, University of Virginia Health System, Charlottesville, VA, 22908, USA

    Stephen Caldwell

Authors
  1. Wael E. A. Saad
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  2. Curtis L. Anderson
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  3. Rahul S. Patel
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  4. Sandra Schwaner
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  5. Stephen Caldwell
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  6. Shawn Pelletier
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  7. John Angle
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  8. Alan H. Matsumoto
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  9. Aaron M. Fischman
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Corresponding author

Correspondence to Wael E. A. Saad.

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Saad, W.E.A., Anderson, C.L., Patel, R.S. et al. Management of Gastric Varices in the Pediatric Population with Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) Utilizing Sodium Tetradecyl Sulfate Foam Sclerosis with or without Partial Splenic Artery Embolization. Cardiovasc Intervent Radiol 38, 236–241 (2015). https://doi.org/10.1007/s00270-014-0881-6

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  • DOI: https://doi.org/10.1007/s00270-014-0881-6

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