Splenic Venous Congestion after Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices

Autor: Bertrand Janne d’Othée, T. Gregory Walker, Alan J. Greenfield, Arthur C. Waltman, John J. A. Marota, Jun Koizumi
Rok vydání: 2011
Předmět:
Zdroj: CardioVascular and Interventional Radiology. 35:434-438
ISSN: 1432-086X
0174-1551
DOI: 10.1007/s00270-011-0160-8
Popis: IntroductionAlthough esophageal veins are the main source of varicealbleeding due to portal hypertension, gastric varices are caus-ative in 10–36% [1]. In the latter, variceal rupture is the mostfearedcomplication,withprevalencearound30%[2–4]andamortality of 45–55% [2–6]. Transjugular intrahepatic porto-systemic shunt (TIPS) for this indication has less favourableresultsthanforesophagealvaricealhemorrhage:successratesfor controlling gastric varices range from 50–63% [6, 7]versus 81% in esophageal varices [8]. Variceal coilingrequires either a percutaneous transhepatic approach (with itsinherent risks), or TIPS creation to allow access. Balloon-occluded retrograde transvenous obliteration (BRTO) hasbeen used to treat and prevent gastric variceal rupture, withbleeding control rates of 87–100%, and recurrence rates of0–10% [6, 9, 10]. Balloon-occluded retrograde transvenousobliterationmaypotentiallyimprovehepatopetalportalbloodflow and hepatic function [6] and, compared to TIPS, providelowercumulative rebleedingratesfromgastric varices (2% at1 year vs. 20% with TIPS) and higher cumulative survivalrates (76% at 5 years vs. 40%) [11].Splenic venous congestion may occur in associationwith sepsis, congestive heart failure, portal hypertension orsplenic vein obstruction. However, to our knowledge,imaging findings of splenic venous congestion have not yetbeen reported after BRTO. We report a case of BRTO ofextremely large gastric varices in the presence of partialsplenoportal thrombosis, in which post procedural com-puted tomography (CT) appearance and clinical evolutionsuggested increased regional venous pressure and paren-chymal splenic congestion.Case ReportA 58-year-old man with known hepatic cirrhosis andremote alcoholism presented with increasing abdominalpain. Model for End-Stage Liver Disease score was 12.Contrast-enhanced CT (CECT) showed partially obstruct-ing thrombus in the splenic and main portal veins, a largegastro renal shunt and gastric varices (Fig. 1). Anticoagu-lation for the thrombosis was contraindicated as a result ofthrombocytopenia (range 20–50,000 mm
Databáze: OpenAIRE
Externí odkaz: