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Catherine E Hansing, Joseph P Marquardt, Daniel M Sutton, John D York
Arteriovenous malformations (AVMs) are a high-flow form of a vascular malformation, which can be found anywhere in the body. While historically treated surgically, a multidisciplinary approach utilizing multiple specialties and treatment modalities is now commonly employed. In order to effectively treat an AVM, the nidus must be targeted and eradicated, which can be done via multiple approaches. We present the case of a 43-year-old male with a gastric wall AVM, which was initially incompletely treated using a percutaneous transarterial approach...
September 26, 2016: Cardiovascular and Interventional Radiology
Qiong Wu, Hua Jiang, Enqiang Linghu, Lanjing Zhang, Weifeng Wang, Jie Zhang, Zhandi He, Juan Wang, Yunsheng Yang, Guohui Sun, Gang Sun
AIMS: We evaluated the feasibility, efficacy and safety of a novel technique of balloon-occluded retrograde transvenous obliteration (BRTO) assisted endoscopic Histoacryl (N-buthyl-2-cyanoacrylate) injection. MATERIAL AND METHODS: A total with 11 patients were enrolled and analyzed in this single center, open-label, prospective study. Patients with high-risk gastric varices (defined as fundal varices, large GV (>5 mm), presence of a red spot, and Child-Pugh score C) and concurrent gastrorenal shunt underwent endoscopic Histoacryl injection while the gastrorenal shunt was temporarily occluded with an occlusion balloon...
June 16, 2016: Minimally Invasive Therapy & Allied Technologies: MITAT
Akira Yamamoto, Norifumi Nishida, Hiroyasu Morikawa, Atsushi Jogo, Ken Kageyama, Etsuji Sohgawa, Shinichi Hamamoto, Toru Takeshita, Yukimasa Sakai, Toshiyuki Matsuoka, Norifumi Kawada, Yukio Miki
PURPOSE: To investigate predictive factors and cutoff value of transient elastography (TE) measurements for assessing improvement in liver function after balloon-occluded retrograde transvenous obliteration (BRTO) for gastric varices (GV). MATERIALS AND METHODS: Retrospective analysis was performed of 50 consecutive patients followed for > 3 months after BRTO, who had undergone TE before BRTO between January 2011 and February 2015. The correlation between change in liver function (total bilirubin, albumin, and prothrombin time) and baseline liver function values and liver stiffness measurement (LSM) by TE was evaluated by Pearson correlation test...
August 2016: Journal of Vascular and Interventional Radiology: JVIR
Nobuyuki Toshikuni, Yoshitaka Takuma, Mikihiro Tsutsumi
Bleeding from gastroesophageal varices (GEV) is a serious event in cirrhotic patients and can cause death. According to the explosion theory, progressive portal hypertension is the primary mechanism underlying variceal bleeding. There are two approaches for treating GEV: primary prophylaxis to manage bleeding or emergency treatment for bleeding followed by secondary prophylaxis. Treatment methods can be classified into two categories: 1) Those used to decrease portal pressure, such as medication (i.e., nonselective β-blockers), radiological intervention [transjugular intrahepatic portosystemic shunt (TIPS)] or a surgical approach (i...
May 2016: Annals of Hepatology
Thomas R McCarty, Mena Bakhit, Tarun Rustagi
Isolated gastric varices are far less prevalent in Western countries where the rate of splenic thrombosis is much lower. However, in Asian countries the entity is more common and therefore a more robust treatment approach has been developed. Balloon-occlusive retrograde transvenous obliteration (BRTO) was first described in 1984 and then revived in 1996. The procedure, while uncommon in the U.S. and not recognized by the AASLD practice guidelines, allows for direct exclusion from the portosystemic system. Here we describe the case of a patient with alcoholic cirrhosis decompensated by bleeding gastric varices treated with BRTO...
March 2016: Journal of Gastrointestinal and Liver Diseases: JGLD
Il Soo Chang, Sang Woo Park, So Young Kwon, Won Hyeok Choe, Young Koog Cheon, Chan Sup Shim, Tae Yoon Lee, Jeong Han Kim
OBJECTIVE: To evaluate the efficacy and safety of balloon-occluded retrograde transvenous obliteration (BRTO) with sodium tetradecyl sulfate (STS) liquid sclerotherapy of gastric varices. MATERIALS AND METHODS: Between February 2012 and August 2014, STS liquid sclerotherapy was performed in 17 consecutive patients (male:female = 8:9; mean age 58.6 years, range 44-86 years) with gastric varices. Retrograde venography was performed after occlusion of the gastrorenal shunt using a balloon catheter and embolization of collateral draining veins using coils or gelfoam pledgets, to evaluate the anatomy of the gastric varices...
March 2016: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
Young Hwan Kim, Young Hwan Kim, Chan Sun Kim, Ung Rae Kang, See Hyung Kim, Joo Hwan Kim
PURPOSE: To compare the clinical outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) using ethanolamine oleate (EO), BRTO using sodium tetradecyl sulfate (STS) foam, and vascular plug-assisted retrograde transvenous obliteration (PARTO). MATERIALS AND METHODS: From April 2004 to February 2015, ninety-five patients underwent retrograde transvenous obliteration for gastric varices were analyzed retrospectively. BRTO with EO was performed in 49 patients, BRTO with STS foam in 25, and PARTO in 21...
June 2016: Cardiovascular and Interventional Radiology
Yun-Bing Wang, Jian-Ying Zhang, Jian-Ping Gong, Fan Zhang, Yong Zhao
BACKGROUND AND AIM: The aim of this study was to compare the feasibility and safety of both balloon-occluded retrograde transvenous obliteration (BRTO) versus transjugular intrahepatic portosystemic shunt (TIPS) for treatment of gastric varices due to portal hypertension through the method of meta-analysis. METHODS: PubMed, Embase, and Cochrane Library were searched for both randomized controlled trials and cohort studies concerning BRTO compared with TIPS in the treatment of gastric varices from their inception to April 26, 2015...
April 2016: Journal of Gastroenterology and Hepatology
Zhassulan Baimakhanov, Akihiko Soyama, Mitsuhisa Takatsuki, Yusuke Inoue, Hajime Matsushima, Masaaki Hidaka, Amane Kitasato, Tomohiko Adachi, Tamotsu Kuroki, Ichiro Sakomoto, Susumu Eguchi
Balloon-occluded retrograde transvenous obliteration (BRTO) has become a common and effective procedure for treating hepatic encephalopathy due to a portosystemic shunt related to cirrhosis of the liver. However, this method of treatment has rarely been reported in patients after liver transplantation. Here, we report the case of a 52-year-old patient who underwent living donor liver transplantation (LDLT) due to hepatitis C virus-infected hepatocellular carcinoma that was complicated with portal vein thrombosis and a large portosystemic shunt between the superior mesenteric vein (SMV) and inferior vena cava (IVC)...
August 2014: Clinical Journal of Gastroenterology
Alexander Copelan, Monzer Chehab, Purushottam Dixit, Mitchell S Cappell
UNLABELLED: BACKGROUND/RATIONALE OF STUDY: Analyze safety and efficacy of angiographic-occlusion-with-sclerotherapy/embolotherapy-without-transjugular-intrahepatic-portosystemic-shunt (TIPS) for duodenal varices. Although TIPS is considered the best intermediate-to-long term therapy after failed endoscopic therapy for bleeding varices, the options are not well-defined when TIPS is relatively contraindicated, with scant data on alternative therapies due to relative rarity of duodenal varices...
May 2015: Annals of Hepatology
Vivek A Saraswat, Abhai Verma
Bleeding from gastric varices (GV) continues to pose a challenge to the endoscopist and no consensus has been reached on the best way for treating these patients. Gastric variceal obturation (GVO) with the tissue adhesive, N-2-butyl-cyanoacrylate (NBC), is considered the treatment of first-choice for this condition in most parts of the world. The liquid monomer polymerizes into a solid cast, obturating the vessel within 10-20 s of coming in contact with ionic solutions such as blood. Gastric variceal obturation achieves hemostasis in over 90% of patients with active bleeding, eradicates GV in over 80% of these patients, and re-bleeding occurs in 3-30%...
March 2012: Journal of Clinical and Experimental Hepatology
Tadahiro Goto, Ippei Matsumoto, Makoto Shinzeki, Hirochika Toyama, Sadaki Asari, Azusa Ueta, Jun Ishida, Yoshihide Nanno, Shinichi So, Hisoka Kinoshita, Taku Matsumoto, Kaori Kuramitsu, Motofumi Tanaka, Atsushi Takebe, Masahiro Kido, Tetsuo Ajiki, Takumi Fukumoto, Yonson Ku
Here, we report a case of Hassab's operation for left-sided portal hypertension after pancreatoduodenectomy. A 69-year old man underwent pancreatoduodenectomy for pancreatic cancer in 2006 in which the splenic vein was ligated near the portal vein and then divided. The patient suffered repeated episodes of anemia between 2010 and 2013. However, we could not identify the bleeding site at that time. In 2011, local recurrence was detected. Disease progression occurred despite chemotherapy treatment, which was then discontinued...
November 2014: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Vinaya Gaduputi, Harish Patel, Sailaja Sakam, Srivani Neshangi, Rafeeq Ahmed, Michael Lombino, Sridhar Chilimuri
INTRODUCTION: Portal hypertension results from increased resistance to portal blood flow and has the potential complications of variceal bleeding and ascites. The splenoportal veins increase in caliber with worsening portal hypertension, and partially decompress by opening a shunt with systemic circulation, ie, a varix. In the event of portosystemic shunting, there is a differential decompression across the portal vein and splenic vein (portal vein > splenic vein), with a resultant decrease in the ratio of portal vein diameter to that of splenic vein...
2015: Clinical and Experimental Gastroenterology
Wael E Saad, Allison Lippert, Sandra Schwaner, Abdullah Al-Osaimi, Saher Sabri, Nael Saad
OBJECTIVES: Endoscopic experience in the management of duodenal varices (DVs) is limited and challenging given the anatomic constraints and limited experience. The endovascular management of DVs is not yet established and the controversy of whether to manage them by decompression with a transjugular intrahepatic portosystemic shunt (TIPS) or by transvenous obliteration is unresolved. In the literature, the 6-12 month rebleeding rate of DVs after TIPS is 21-37% and after transvenous obliteration is 13%...
2014: Journal of Clinical Imaging Science
Jonathan K Park, Sammy Saab, Stephen T Kee, Ronald W Busuttil, Hyun J Kim, Francsico Durazo, Sung-Ki Cho, Edward Wolfgang Lee
AIM: To perform a systematic review and meta-analysis of the effectiveness and complications of BRTO for gastric varices. MATERIALS AND METHODS: A systematic review was performed to identify relevant articles. Inclusion criteria were applied to select studies with at least ten patients with acute bleeding or at-risk gastric varices treated with BRTO. Meta-analysis with random effects model was performed to calculate data for immediate technical success, clinical success, and complications...
June 2015: Digestive Diseases and Sciences
Wael E Saad
Bleeding from gastric varices is a major complication of portal hypertension. Although less common than bleeding associated with esophageal varices, gastric variceal bleeding has a higher mortality. From an endovascular perspective,transjugular intrahepatic portosystemic shunts (TIPS) to decompress the portal circulation and/or balloon-occluded retrograde transvenous obliteration (BRTO) are utilized to address bleeding gastric varices. Until recently, there was a clear medical cultural divide between the strategy of decompressing the portal circulation (TIPS creation, for example) and transvenous obliteration for the management of gastric varices...
November 2014: Clinics in Liver Disease
Hiroshi Kakutani, Jun Sanada, Daiju Nakayama, Fuminori Moriyasu
PURPOSE: We evaluated the effectiveness of catheter-retaining balloon-occluded retrograde transvenous obliteration (BRTO). PATIENTS AND METHODS: Patients were divided into 2 groups based on concurrent contrast imaging findings. The primary endpoint was effectiveness, the secondary endpoint was complications, and the tertiary endpoint was recurrence of esophageal varices in all cases. RESULTS: The mean volume of EO administered was 16.43 ± 4...
2014: Journal of Nippon Medical School, Nippon Ika Daigaku Zasshi
Wael E Saad
The American College of Radiology Appropriateness Criteria Committee on interventional radiology has recently recognized balloon-occluded retrograde transvenous obliteration (BRTO) as a viable alternative to transjugular intrahepatic portosystemic shunt (TIPS) in certain anatomic and clinical scenarios for the management of gastric varices. However, it did not define these particular scenarios where BRTO would be a viable alternative. With the increased practice of BRTO in the United States, a debate ensues in the United States and Europe whether BRTO or TIPS should be the primary endovascular procedure of choice for gastric varices...
September 2014: Seminars in Interventional Radiology
W E Saad, W Bleibel, N Adenaw, C E Wagner, C Anderson, J F Angle, A M Al-Osaimi, M G Davies, S Caldwell
OBJECTIVES: Gastric varices primarily occur in cirrhotic patients with portal hypertension and splenomegaly and thus are probably associated with thrombocytopenia. However, the prevalence and severity of thrombocytopenia are unknown in this clinical setting. Moreover, one-third of patients after balloon-occluded retrograde transvenous obliteration (BRTO) have aggravated splenomegaly, which potentially may cause worsening thrombocytopenia. The aim of the study is to determine the prevalence and degree of thrombocytopenia in patients with gastric varices associated with gastrorenal shunts undergoing BRTO, to determine the prognostic factors of survival after BRTO (platelet count included), and to assess the effect of BRTO on platelet count over a 1-year period...
2014: Journal of Clinical Imaging Science
Wael E A Saad, Curtis L Anderson, Rahul S Patel, Sandra Schwaner, Stephen Caldwell, Shawn Pelletier, John Angle, Alan H Matsumoto, Aaron M Fischman
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)...
February 2015: Cardiovascular and Interventional Radiology
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