Korean Journal of Radiology

  • 제19권2호
  • /
  • Pages.223-229
  • /
  • 2018
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Gastric Varices: The Role of Intra-Procedural Cone-Beam Computed Tomography

  • Gwon, Dong Il (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Ko, Gi-Young (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kwon, Young Baek (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Yoon, Hyun-Ki (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Sung, Kyu-Bo (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
  • 투고 : 2017.06.21
  • 심사 : 2017.08.07
  • 발행 : 2018.04.01
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To investigate the technical and clinical outcomes of plug-assisted retrograde transvenous obliteration (PARTO) for the treatment of gastric varices (GV) and to evaluate the role of intra-procedural cone-beam computed tomography (CBCT) performed during PARTO to confirm its technical success. Materials and Methods: From January 2016 to December 2016, 17 patients with GV who had undergone PARTO were retrospectively evaluated. When the proximal part of the afferent vein was identified on a fluoroscopy, non-contrast CBCT images were obtained. In patients with incomplete embolization of GV, an additional injection of gelatin sponges was performed. Follow-up data from contrast-enhanced CT and upper intestinal endoscopy, as well as clinical and laboratory data were collected. Results: Plug-assisted retrograde transvenous obliteration procedures were technically successful in all 17 patients. Complete embolization of GV was detected on CBCT images in 15 patients; whereas, incomplete embolization was detected in two. Complete embolization of GV was then achieved after an additional injection of gelatin sponges in these two patients as demonstrated on the 2nd CBCT image. The mean follow-up period after PARTO was 193 days (range, 73-383 days). A follow-up CT obtained 2-4 months after PARTO demonstrated marked shrinkage or complete obliteration of GV and portosystemic shunts in all 17 patients. There were no cases of variceal bleeding during the follow-up. Conclusion: Plug-assisted retrograde transvenous obliteration is technically and clinically effective for the treatment of GV. In addition, intra-procedural CBCT can be an adjunct tool to fluoroscopy, because it can provide an immediate and accurate evaluation of the technical success of PARTO.

키워드

참고문헌

  1. de Franchis R, Primignani M. Natural history of portal hypertension in patients with cirrhosis. Clin Liver Dis 2001;5:645-663 https://doi.org/10.1016/S1089-3261(05)70186-0
  2. Trudeau W, Prindiville T. Endoscopic injection sclerosis in bleeding gastric varices. Gastrointest Endosc 1986;32:264-268 https://doi.org/10.1016/S0016-5107(86)71843-9
  3. Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology 1992;16:1343-1349 https://doi.org/10.1002/hep.1840160607
  4. Kanagawa H, Mima S, Kouyama H, Gotoh K, Uchida T, Okuda K. Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol 1996;11:51-58 https://doi.org/10.1111/j.1440-1746.1996.tb00010.x
  5. Chikamori F, Kuniyoshi N, Shibuya S, Takase Y. Eight years of experience with transjugular retrograde obliteration for gastric varices with gastrorenal shunts. Surgery 2001;129:414-420 https://doi.org/10.1016/S0039-6060(01)21563-3
  6. Fukuda T, Hirota S, Sugimura K. Long-term results of balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy. J Vasc Interv Radiol 2001;12:327-336 https://doi.org/10.1016/S1051-0443(07)61912-5
  7. Cho SK, Shin SW, Lee IH, Do YS, Choo SW, Park KB, et al. Balloon-occluded retrograde transvenous obliteration of gastric varices: outcomes and complications in 49 patients. AJR Am J Roentgenol 2007;189:W365-W372 https://doi.org/10.2214/AJR.07.2266
  8. Choi SY, Won JY, Kim KA, Lee DY, Lee KH. Foam sclerotherapy using polidocanol for balloon-occluded retrograde transvenous obliteration (BRTO). Eur Radiol 2011;21:122-129 https://doi.org/10.1007/s00330-010-1895-3
  9. Chang IS, Park SW, Kwon SY, Choe WH, Cheon YK, Shim CS, et al. Efficacy and safety of balloon-occluded retrograde transvenous obliteration with sodium tetradecyl sulfate liquid sclerotherapy. Korean J Radiol 2016;17:224-229 https://doi.org/10.3348/kjr.2016.17.2.224
  10. Ninoi T, Nishida N, Kaminou T, Sakai Y, Kitayama T, Hamuro M, 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;184:1340-1346 https://doi.org/10.2214/ajr.184.4.01841340
  11. Kim SK, Lee KA, Sauk S, Korenblat K. Comparison of transjugular intrahepatic portosystemic shunt with covered stent and balloon-occluded retrograde transvenous obliteration in managing isolated gastric varices. Korean J Radiol 2017;18:345-354 https://doi.org/10.3348/kjr.2017.18.2.345
  12. Akahoshi T, Hashizume M, Tomikawa M, Kawanaka H, Yamaguchi S, Konishi K, et al. Long-term results of balloonoccluded retrograde transvenous obliteration for gastric variceal bleeding and risky gastric varices: a 10-year experience. J Gastroenterol Hepatol 2008;23:1702-1709 https://doi.org/10.1111/j.1440-1746.2008.05549.x
  13. Sabri SS, Swee W, Turba UC, Saad WE, Park AW, Al-Osaimi AM, et al. Bleeding gastric varices obliteration with balloonoccluded retrograde transvenous obliteration using sodium tetradecyl sulfate foam. J Vasc Interv Radiol 2011;22:309- 316; quiz 316 https://doi.org/10.1016/j.jvir.2010.11.022
  14. Kim MY, Um SH, Baik SK, Seo YS, Park SY, Lee JI, et al. Clinical features and outcomes of gastric variceal bleeding: retrospective Korean multicenter data. Clin Mol Hepatol 2013;19:36-44 https://doi.org/10.3350/cmh.2013.19.1.36
  15. Imai Y, Nakazawa M, Ando S, Sugawara K, Mochida S. Longterm outcome of 154 patients receiving balloon-occluded retrograde transvenous obliteration for gastric fundal varices. J Gastroenterol Hepatol 2016;31:1844-1850 https://doi.org/10.1111/jgh.13382
  16. Gwon DI, Ko GY, Yoon HK, Sung KB, Kim JH, Shin JH, et al. Gastric varices and hepatic encephalopathy: treatment with vascular plug and gelatin sponge-assisted retrograde transvenous obliteration--a primary report. Radiology 2013;268:281-287 https://doi.org/10.1148/radiol.13122102
  17. Gwon DI, Kim YH, Ko GY, Kim JW, Ko HK, Kim JH, et al. Vascular plug-assisted retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy: a prospective multicenter study. J Vasc Interv Radiol 2015;26:1589-1595 https://doi.org/10.1016/j.jvir.2015.07.011
  18. Kim T, Yang H, Lee CK, Kim GB. Vascular plug assisted retrograde transvenous obliteration (PARTO) for gastric varix bleeding patients in the emergent clinical setting. Yonsei Med J 2016;57:973-979 https://doi.org/10.3349/ymj.2016.57.4.973
  19. Chang MY, Kim MD, Kim T, Shin W, Shin M, Kim GM, et al. Plug-assisted retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage. Korean J Radiol 2016;17:230-238 https://doi.org/10.3348/kjr.2016.17.2.230
  20. Deschamps F, Solomon SB, Thornton RH, Rao P, Hakime A, Kuoch V, et al. Computed analysis of three-dimensional conebeam computed tomography angiography for determination of tumor-feeding vessels during chemoembolization of liver tumor: a pilot study. Cardiovasc Intervent Radiol 2010;33:1235-1242 https://doi.org/10.1007/s00270-010-9846-6
  21. Hirota S, Nakao N, Yamamoto S, Kobayashi K, Maeda H, Ishikura R, et al. Cone-beam CT with flat-panel-detector digital angiography system: early experience in abdominal interventional procedures. Cardiovasc Intervent Radiol 2006;29:1034-1038 https://doi.org/10.1007/s00270-005-0287-6
  22. Koizumi J, Hashimoto T, Myojin K, Fukushima T, Ichikawa T, Kagawa T, et al. C-arm CT-guided foam sclerotherapy for the treatment of gastric varices. J Vasc Interv Radiol 2010;21:1583-1587 https://doi.org/10.1016/j.jvir.2010.05.029
  23. Yamagami T, Yoshimatsu R, Miura H, Tanaka O, Yasui K, Yagi N, et al. Usefulness of cone-beam computed tomography during balloon-occluded retrograde transvenous obliteration. Minim Invasive Ther Allied Technol 2013;22:359-363 https://doi.org/10.3109/13645706.2013.808230
  24. Lee EW, So N, Chapman R, McWilliams JP, Loh CT, Busuttil RW, et al. Usefulness of intra-procedural cone-beam computed tomography in modified balloon-occluded retrograde transvenous obliteration of gastric varices. World J Radiol 2016;8:390-396 https://doi.org/10.4329/wjr.v8.i4.390
  25. Hashizume M, Kitano S, Yamaga H, Sugimachi K. Haptoglobin to protect against renal damage from ethanolamine oleate sclerosant. Lancet 1988;2:340-341
  26. Lee EW, Saab S, Gomes AS, Busuttil R, McWilliams J, Durazo F, et al. Coil-assisted retrograde transvenous obliteration (CARTO) for the treatment of portal hypertensive variceal bleeding: preliminary results. Clin Transl Gastroenterol 2014;5:e61 https://doi.org/10.1038/ctg.2014.12

피인용 문헌

  1. Treatment outcomes of percutaneous transhepatic variceal embolization versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding vol.98, pp.18, 2018, https://doi.org/10.1097/md.0000000000015464
  2. Characteristics of Recent Articles Published in the Korean Journal of Radiology Based on the Citation Frequency vol.21, pp.12, 2020, https://doi.org/10.3348/kjr.2020.1322