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Balloon-occluded retrograde transvenous obliteration of gastric varices: use of CT-guided foam sclerotherapy to optimize technique.
- Source :
-
AJR. American journal of roentgenology [AJR Am J Roentgenol] 2012 Jul; Vol. 199 (1), pp. 200-7. - Publication Year :
- 2012
-
Abstract
- Objective: Balloon-occluded retrograde transvenous obliteration has been traditionally based on liquid sclerotherapy. However, overdose and systemic spillage of liquid sclerosant can cause severe complications, such as hemolysis, which lead to hemoglobinuria, allergy, acute respiratory distress syndrome, and other disorders. The purpose of this study was to evaluate the performance of foam sclerotherapy with C-arm CT guidance to reduce the amount of sclerosant and to optimize the safety of balloon-occluded retrograde transvenous obliteration while preserving its efficacy.<br />Materials and Methods: Twenty consecutively registered patients with gastric varices underwent balloon-occluded retrograde transvenous obliteration with polidocanol foam. C-arm CT guidance was used to confirm gas filling of the target vessels. In this retrospective analysis of a prospectively encoded database, total net doses of polidocanol used for transvenous obliteration and of contrast medium used for venography before transvenous obliteration were compared, and subsequent complications, including hemoglobinuria, were documented.<br />Results: In all patients, foam was observed in the target vessels at C-arm CT. The mean dose of polidocanol used for balloon-occluded retrograde transvenous obliteration (3.9 ± 1.5 mL) was significantly smaller (p < 0.001) than the dose of contrast medium used for venography (16.4 ± 7.9 mL). Hemoglobinuria was found in only one patient. Except in one instance of recanalization, full variceal thrombosis was confirmed at contrast-enhanced CT 1 week after transvenous obliteration (success rate, 95%). In one patient, air migrated into the liver during transvenous obliteration but was spontaneously absorbed. No serious complication occurred.<br />Conclusion: Balloon-occluded retrograde transvenous obliteration with polidocanol foam under C-arm CT guidance allowed significant reduction of sclerosant dose and resulted in a low complication rate while a high technical success rate and efficacy were maintained.
- Subjects :
- Aged
Aged, 80 and over
Balloon Occlusion adverse effects
Contrast Media
Female
Hemoglobinuria etiology
Hemoglobinuria prevention & control
Humans
Male
Middle Aged
Phlebography methods
Polidocanol
Radiographic Image Enhancement
Retrospective Studies
Sclerotherapy adverse effects
Tomography, X-Ray Computed
Treatment Outcome
Balloon Occlusion methods
Esophageal and Gastric Varices diagnostic imaging
Esophageal and Gastric Varices therapy
Polyethylene Glycols administration & dosage
Sclerosing Solutions administration & dosage
Sclerotherapy methods
Subjects
Details
- Language :
- English
- ISSN :
- 1546-3141
- Volume :
- 199
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- AJR. American journal of roentgenology
- Publication Type :
- Academic Journal
- Accession number :
- 22733913
- Full Text :
- https://doi.org/10.2214/AJR.11.7002