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Anatomic features and retrograde transvenous obliteration of duodenal varices associated with mesocaval collateral pathway.
J Vasc Interv Radiol. 2012 Oct; 23(10):1339-46.JV

Abstract

PURPOSE

To evaluate techniques and efficacy of retrograde transvenous obliteration for the treatment of duodenal varices associated with mesocaval collateral pathway.

MATERIALS AND METHODS

Six consecutive cases of large/growing or ruptured duodenal varices treated by retrograde transvenous obliteration were retrospectively reviewed. Selective balloon-occluded retrograde transvenous obliteration (B-RTO) with 5% ethanolamine oleate (EO) was performed in all cases. When EO could not be sufficiently stagnated in the varices, additional/alternative techniques were performed, including coil embolization of afferent vein or intravariceal injection of n-butyl-2-cyanoacrylate (NBCA). Clinical findings, anatomic features of duodenal varices, obliteration techniques, complications, posttherapeutic computed tomography (CT) findings, and follow-up endoscopic findings were investigated.

RESULTS

All duodenal varices were located at the second/third junction of the duodenum and were fed by single (n = 1) or multiple (n = 5) pancreaticoduodenal veins. One varix fed by a single afferent vein was successfully treated by simple selective B-RTO technique alone. The other five cases required coil embolization of afferent vein (n = 1) or intravariceal injection of NBCA (n = 4) because sclerosant was not sufficiently stagnated in the varices. CT 1 week after the procedure showed complete occlusion of the varices in all cases. A duodenal ulcer at the variceal site developed in one patient and was successfully treated by medication. Follow-up endoscopy showed disappearance of varices in all cases, and no recurrence was observed during follow-up.

CONCLUSIONS

Retrograde transvenous obliteration is an effective technique for the treatment of duodenal varices. However, additional/alternative techniques are required for successful treatment because of the complex anatomic features of duodenal varices.

Authors+Show Affiliations

Department of Radiology, Faculty of Medicine, Oita University, Yufu-shi, Oita, Japan. okahara@oita-u.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22999754

Citation

Okahara, Mika, et al. "Anatomic Features and Retrograde Transvenous Obliteration of Duodenal Varices Associated With Mesocaval Collateral Pathway." Journal of Vascular and Interventional Radiology : JVIR, vol. 23, no. 10, 2012, pp. 1339-46.
Okahara M, Kiyosue H, Ueda S, et al. Anatomic features and retrograde transvenous obliteration of duodenal varices associated with mesocaval collateral pathway. J Vasc Interv Radiol. 2012;23(10):1339-46.
Okahara, M., Kiyosue, H., Ueda, S., Kashiwagi, J., Tanoue, S., Hongo, N., & Mori, H. (2012). Anatomic features and retrograde transvenous obliteration of duodenal varices associated with mesocaval collateral pathway. Journal of Vascular and Interventional Radiology : JVIR, 23(10), 1339-46. https://doi.org/10.1016/j.jvir.2012.06.030
Okahara M, et al. Anatomic Features and Retrograde Transvenous Obliteration of Duodenal Varices Associated With Mesocaval Collateral Pathway. J Vasc Interv Radiol. 2012;23(10):1339-46. PubMed PMID: 22999754.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anatomic features and retrograde transvenous obliteration of duodenal varices associated with mesocaval collateral pathway. AU - Okahara,Mika, AU - Kiyosue,Hiro, AU - Ueda,Sinya, AU - Kashiwagi,Junji, AU - Tanoue,Shuichi, AU - Hongo,Norio, AU - Mori,Hiromu, PY - 2012/04/28/received PY - 2012/06/25/revised PY - 2012/06/29/accepted PY - 2012/9/25/entrez PY - 2012/9/25/pubmed PY - 2013/4/9/medline SP - 1339 EP - 46 JF - Journal of vascular and interventional radiology : JVIR JO - J Vasc Interv Radiol VL - 23 IS - 10 N2 - PURPOSE: To evaluate techniques and efficacy of retrograde transvenous obliteration for the treatment of duodenal varices associated with mesocaval collateral pathway. MATERIALS AND METHODS: Six consecutive cases of large/growing or ruptured duodenal varices treated by retrograde transvenous obliteration were retrospectively reviewed. Selective balloon-occluded retrograde transvenous obliteration (B-RTO) with 5% ethanolamine oleate (EO) was performed in all cases. When EO could not be sufficiently stagnated in the varices, additional/alternative techniques were performed, including coil embolization of afferent vein or intravariceal injection of n-butyl-2-cyanoacrylate (NBCA). Clinical findings, anatomic features of duodenal varices, obliteration techniques, complications, posttherapeutic computed tomography (CT) findings, and follow-up endoscopic findings were investigated. RESULTS: All duodenal varices were located at the second/third junction of the duodenum and were fed by single (n = 1) or multiple (n = 5) pancreaticoduodenal veins. One varix fed by a single afferent vein was successfully treated by simple selective B-RTO technique alone. The other five cases required coil embolization of afferent vein (n = 1) or intravariceal injection of NBCA (n = 4) because sclerosant was not sufficiently stagnated in the varices. CT 1 week after the procedure showed complete occlusion of the varices in all cases. A duodenal ulcer at the variceal site developed in one patient and was successfully treated by medication. Follow-up endoscopy showed disappearance of varices in all cases, and no recurrence was observed during follow-up. CONCLUSIONS: Retrograde transvenous obliteration is an effective technique for the treatment of duodenal varices. However, additional/alternative techniques are required for successful treatment because of the complex anatomic features of duodenal varices. SN - 1535-7732 UR - https://www.unboundmedicine.com/medline/citation/22999754/Anatomic_features_and_retrograde_transvenous_obliteration_of_duodenal_varices_associated_with_mesocaval_collateral_pathway_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1051-0443(12)00693-8 DB - PRIME DP - Unbound Medicine ER -