American Journal of Roentgenology Interventional Radiology

[Interventional Radiology] Gastric Varices with Gastrorenal Shunt: Combined Therapy Using Transjugular Retrograde Obliteration and Partial Splenic Embolization

Chikamori, F., Kuniyoshi, N., Kawashima, T., Takase, Y. — 2008-07-22

OBJECTIVE. This study was prospectively conducted to evaluate the effectiveness of the combination of transjugular retrograde obliteration and partial splenic embolization in the treatment of gastric varices with gastrorenal shunt.

SUBJECTS AND METHODS. Between November 2002 and December 2006, 14 patients with gastric varices and gastrorenal shunt were treated by combining transjugular retrograde obliteration and partial splenic embolization (group 1). These patients were compared with 19 patients with gastric varices and gastrorenal shunt treated by only transjugular retrograde obliteration (group 2) for the disappearance rate of gastric varices, the cumulative survival rate, and the occurrence rate of esophageal varices after transjugular retrograde obliteration. Partial splenic embolization was performed 7–14 days before transjugular retrograde obliteration. No significant differences were seen between the two groups in terms of demographic data, including age, sex, and Child-Pugh classification.

RESULTS. The disappearance rate of gastric varices after transjugular retrograde obliteration was 100% in both groups. The 3-year cumulative survival rate after transjugular retrograde obliteration was 92% in group 1 and 95% in group 2. The 3-year cumulative occurrence rate of esophageal varices after transjugular retrograde obliteration was 9% in group 1 and 45% in group 2, a significant difference (p < 0.05).

CONCLUSION. The findings of this study indicate that partial splenic embolization contributed to preventing portal congestion after transjugular retrograde obliteration. We conclude that the combination of transjugular retrograde obliteration and partial splenic embolization for gastric varices is more effective than transjugular retrograde obliteration only in the long-term prevention of esophageal varices after transjugular retrograde obliteration.

[Interventional Radiology] Percutaneous Sonographic Guidance for TIPS in Budd-Chiari Syndrome: Direct Simultaneous Puncture of the Portal Vein and Inferior Vena Cava

Boyvat, F., Harman, A., Ozyer, U., Aytekin, C., Arat, Z. — 2008-07-22

OBJECTIVE. Budd-Chiari syndrome (BCS) is a clinical condition characterized by hepatic venous outflow obstruction. A transjugular intrahepatic portosystemic shunt (TIPS) is an effective means of decompressing the portal system in patients unresponsive to traditional medical therapy. TIPS may be difficult in patients with BCS owing to the presence of hepatic venous occlusive disease. We present our experience using direct percutaneous simultaneous puncture of the portal vein and the inferior vena cava to place a TIPS in patients with BCS.

MATERIALS AND METHODS. Between September 2003 and October 2006, percutaneous sonographically guided TIPS was performed on 11 patients (five women and a girl, four men and a boy; age range, 6–43 years). Indications for the TIPS procedure were intractable ascites in nine patients and intractable ascites and variceal bleeding in two patients.

RESULTS. Technical success was achieved in all patients. The mean portosystemic pressure gradient was reduced from 23.5 to 9.8 mm Hg. The cumulative rate of primary patency was 60% at 1 year. Nine revisions were performed in five patients. In nine of the 11 patients, ascites resolved completely, and in two patients, it was relieved.

CONCLUSION. Excellent technical and clinical success can be achieved with percutaneous sonographically guided direct simultaneous puncture of the portal vein and inferior vena cava in patients with BCS.

[Interventional Radiology] Phrenic Nerve Injury Resulting from Percutaneous Ablation of Lung Malignancy

Thornton, R. H., Solomon, S. B., Dupuy, D. E., Bains, M. S. — 2008-07-22

OBJECTIVE. The objective of our study was to illustrate the potential for phrenic nerve injury during percutaneous lung ablation, to discuss the importance of this complication, and to review the expected location of the phrenic nerve on chest CT.

CONCLUSION. Knowledge of the expected location of the phrenic nerve—a structure that is usually not visible on imaging but is important—is essential for avoiding injury to the nerve during pulmonary ablation.