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Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices: Outcomes and Complications in 49 Patients

¹ Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Kangnam-ku, Seoul 135-710, Korea.
² Department of Medicine, Division of Gastroenterology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Balloon-occluded retrograde transvenous obliteration of gastric varices in 67-year-old man with alcoholic liver cirrhosis. Endoscopic image (A) and enhanced CT scan (B) show large gastric fundal varices.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Balloon-occluded retrograde transvenous obliteration of gastric varices in 67-year-old man with alcoholic liver cirrhosis. Endoscopic image (A) and enhanced CT scan (B) show large gastric fundal varices.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Balloon-occluded retrograde transvenous obliteration of gastric varices in 67-year-old man with alcoholic liver cirrhosis. Retrograde left adrenal venogram with balloon occlusion shows inferior phrenic vein (small arrow), but gastric varices are only partially opacified (large arrow).

View larger version (161K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Balloon-occluded retrograde transvenous obliteration of gastric varices in 67-year-old man with alcoholic liver cirrhosis. After microcoil and gelatin sponge embolization of inferior phrenic vein, left adrenal venogram shows all gastric varices (arrow) and retention of contrast medium, although small collateral veins are also opacified. Gastric varices were successfully obliterated with ethanolamine oleate.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —Balloon-occluded retrograde transvenous obliteration of gastric varices in 67-year-old man with alcoholic liver cirrhosis. Contrast-enhanced CT scan obtained 4 days after balloon-occluded retrograde transvenous obliteration shows that gastric varices are completely thrombosed.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1F —Balloon-occluded retrograde transvenous obliteration of gastric varices in 67-year-old man with alcoholic liver cirrhosis. Endoscopic image obtained 6 weeks after obliteration procedure shows marked shrinkage of gastric varices.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Balloon-occluded retrograde transvenous obliteration of gastric varices in 52-year-old man with hepatitis B-related liver cirrhosis. Retrograde left adrenal venograms with balloon occlusion show enlarged pericardiacophrenic vein (arrows), but gastric varices are not opacified.

View larger version (167K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Balloon-occluded retrograde transvenous obliteration of gastric varices in 52-year-old man with hepatitis B-related liver cirrhosis. Retrograde left adrenal venograms with balloon occlusion show enlarged pericardiacophrenic vein (arrows), but gastric varices are not opacified.

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Balloon-occluded retrograde transvenous obliteration of gastric varices in 52-year-old man with hepatitis B-related liver cirrhosis. After simultaneous balloon occlusion of both gastrorenal and gastropericardiophrenic shunts (arrows), gastric varices (arrowhead) are opacified and successfully treated.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Balloon-occluded retrograde transvenous obliteration of duodenal varices in 48-year-old man with hepatitis B-related liver cirrhosis. Patient's duodenal variceal bleeding occurred 6 months after previous obliteration procedure for treatment of gastric varices. Contrast-enhanced CT scan shows multiple duodenal varices (arrow).

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Balloon-occluded retrograde transvenous obliteration of duodenal varices in 48-year-old man with hepatitis B-related liver cirrhosis. Patient's duodenal variceal bleeding occurred 6 months after previous obliteration procedure for treatment of gastric varices. Retrograde right gonadal venogram after microcoil embolization of collateral veins (small arrow) shows opacification of duodenal varices (large arrow), which were treated by injecting mixture of ethanolamine oleate and iodized oil.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Balloon-occluded retrograde transvenous obliteration of duodenal varices in 48-year-old man with hepatitis B-related liver cirrhosis. Patient's duodenal variceal bleeding occurred 6 months after previous obliteration procedure for treatment of gastric varices. CT scan obtained 3 months after procedure shows retention of iodized oil and no contrast enhancement of duodenal varices (arrow). Further CT scan at 6-month follow-up (not shown) showed complete obliteration of duodenal varices.

View larger version (4K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Survival rates after balloon-occluded retrograde transvenous obliteration. Graphs show cumulative survival rate of all patients after balloon-occluded retrograde transvenous obliteration (A), survival rate according to preprocedural Child-Pugh classifications A and B (dotted line) versus classification C (solid line) (B), and survival rates according to preprocedural total bilirubin < 3.5 mg/dL (solid line) versus 3.5 mg/dL (dotted line) (C).

View larger version (6K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Survival rates after balloon-occluded retrograde transvenous obliteration. Graphs show cumulative survival rate of all patients after balloon-occluded retrograde transvenous obliteration (A), survival rate according to preprocedural Child-Pugh classifications A and B (dotted line) versus classification C (solid line) (B), and survival rates according to preprocedural total bilirubin < 3.5 mg/dL (solid line) versus 3.5 mg/dL (dotted line) (C).

View larger version (5K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Survival rates after balloon-occluded retrograde transvenous obliteration. Graphs show cumulative survival rate of all patients after balloon-occluded retrograde transvenous obliteration (A), survival rate according to preprocedural Child-Pugh classifications A and B (dotted line) versus classification C (solid line) (B), and survival rates according to preprocedural total bilirubin < 3.5 mg/dL (solid line) versus 3.5 mg/dL (dotted line) (C).

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