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Balloon-occluded retrograde transvenous obliteration of gastric varix with multiple drainage veins performed with temporal occlusion of the pericardiacophrenic vein with a micro-balloon.

Yamagami T, Iida M, Tanitame N, Yoshimatsu R, Ono C, Waki K, Tsuji K, Awai K - Acta Radiol Open (2015)

Bottom Line: We encountered a case with a gastric varix that drained into the gastro-renal shunt, left pericardiacophrenic vein, and several other dilated collateral veins.Before injection of sclerotic agents, collateral veins other than the left pericardiacophrenic vein were embolized with micro-coils.During the injection, the left pericardiacophrenic vein was occluded temporarily with a micro-balloon catheter coaxially advanced from the catheter inserted from the femoral vein to the left pericardiacophrenic vein through the left brachiocephalic vein.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.

ABSTRACT
We encountered a case with a gastric varix that drained into the gastro-renal shunt, left pericardiacophrenic vein, and several other dilated collateral veins. This patient had a circumaortic venous ring. For this case we successfully performed balloon-occluded retrograde transvenous obliteration in which sclerotic agents were infused from the balloon catheter advanced to the left pre-aortic renal vein and the tip was wedged into the end of the gastro-renal shunt. Before injection of sclerotic agents, collateral veins other than the left pericardiacophrenic vein were embolized with micro-coils. During the injection, the left pericardiacophrenic vein was occluded temporarily with a micro-balloon catheter coaxially advanced from the catheter inserted from the femoral vein to the left pericardiacophrenic vein through the left brachiocephalic vein.

No MeSH data available.


Related in: MedlinePlus

A 62-year-old man with a gastric varix located at the gastric cardia and fornix. (a) Abdominal contrast-enhanced multi-detector row computed tomography (MDCT) showed a gastric varix located in the cardia and fornix of the stomach (arrow). (b) The initial retrograde venography obtained while the balloon (arrowhead) was inflated in the gastro-renal shunt revealed two branches of the left inferior phrenic vein and the left inferior pericardiacophrenic vein (arrow), a vessel communicating with the left retro-aortic renal vein (small arrowhead), and other small veins, all of which had developed as collateral vessels. Note that the gastric varix could not be visualized. (c) Retrograde venography performed after embolization of two branches of the left inferior phrenic vein with microcoils (arrowheads) demonstrates the vessel communicating with the retro-aortic vein (arrows) and other small collateral vessels. Note that the gastric varix is still not evident. (d) Retrograde venography shows the dilated left pericardiacophrenic vein (arrows) that developed as a drainage vein after embolization of the vessel communicating with the retro-aortic vein using micro-coils (arrowhead). (e) Roentgenogram obtained after injection of sclerotic agents performed while the micro-balloon positioned in the left pericardiacophrenic vein was inflated (arrow) showed complete filling of sclerotic agents in the gastric varix (arrowheads). (f) Contrast-enhanced MDCT scan obtained 1 month after the balloon-occluded retrograde transvenous obliteration confirmed complete disappearance of enhancement in the gastric varix (arrow).
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fig1-2047981614558328: A 62-year-old man with a gastric varix located at the gastric cardia and fornix. (a) Abdominal contrast-enhanced multi-detector row computed tomography (MDCT) showed a gastric varix located in the cardia and fornix of the stomach (arrow). (b) The initial retrograde venography obtained while the balloon (arrowhead) was inflated in the gastro-renal shunt revealed two branches of the left inferior phrenic vein and the left inferior pericardiacophrenic vein (arrow), a vessel communicating with the left retro-aortic renal vein (small arrowhead), and other small veins, all of which had developed as collateral vessels. Note that the gastric varix could not be visualized. (c) Retrograde venography performed after embolization of two branches of the left inferior phrenic vein with microcoils (arrowheads) demonstrates the vessel communicating with the retro-aortic vein (arrows) and other small collateral vessels. Note that the gastric varix is still not evident. (d) Retrograde venography shows the dilated left pericardiacophrenic vein (arrows) that developed as a drainage vein after embolization of the vessel communicating with the retro-aortic vein using micro-coils (arrowhead). (e) Roentgenogram obtained after injection of sclerotic agents performed while the micro-balloon positioned in the left pericardiacophrenic vein was inflated (arrow) showed complete filling of sclerotic agents in the gastric varix (arrowheads). (f) Contrast-enhanced MDCT scan obtained 1 month after the balloon-occluded retrograde transvenous obliteration confirmed complete disappearance of enhancement in the gastric varix (arrow).

Mentions: A 62-year-old man with Child’s A class liver cirrhosis caused by hepatitis C virus infection was admitted for treatment of a large gastric varix for prevention of rupture. The patient had an earlier history of bleeding. Endoscopic examination revealed a bead-shaped moderate varix without the red color sign located at the gastric cardia and fornix. Abdominal contrast-enhanced multi-detector row computed tomography (MDCT) confirmed that the gastric varix was located in the cardia and fornix of the stomach (Fig. 1a). There was no sign of ascites. Additionally, the CT images revealed that the patient had a circumaortic venous ring.Fig. 1.


Balloon-occluded retrograde transvenous obliteration of gastric varix with multiple drainage veins performed with temporal occlusion of the pericardiacophrenic vein with a micro-balloon.

Yamagami T, Iida M, Tanitame N, Yoshimatsu R, Ono C, Waki K, Tsuji K, Awai K - Acta Radiol Open (2015)

A 62-year-old man with a gastric varix located at the gastric cardia and fornix. (a) Abdominal contrast-enhanced multi-detector row computed tomography (MDCT) showed a gastric varix located in the cardia and fornix of the stomach (arrow). (b) The initial retrograde venography obtained while the balloon (arrowhead) was inflated in the gastro-renal shunt revealed two branches of the left inferior phrenic vein and the left inferior pericardiacophrenic vein (arrow), a vessel communicating with the left retro-aortic renal vein (small arrowhead), and other small veins, all of which had developed as collateral vessels. Note that the gastric varix could not be visualized. (c) Retrograde venography performed after embolization of two branches of the left inferior phrenic vein with microcoils (arrowheads) demonstrates the vessel communicating with the retro-aortic vein (arrows) and other small collateral vessels. Note that the gastric varix is still not evident. (d) Retrograde venography shows the dilated left pericardiacophrenic vein (arrows) that developed as a drainage vein after embolization of the vessel communicating with the retro-aortic vein using micro-coils (arrowhead). (e) Roentgenogram obtained after injection of sclerotic agents performed while the micro-balloon positioned in the left pericardiacophrenic vein was inflated (arrow) showed complete filling of sclerotic agents in the gastric varix (arrowheads). (f) Contrast-enhanced MDCT scan obtained 1 month after the balloon-occluded retrograde transvenous obliteration confirmed complete disappearance of enhancement in the gastric varix (arrow).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4552181&req=5

fig1-2047981614558328: A 62-year-old man with a gastric varix located at the gastric cardia and fornix. (a) Abdominal contrast-enhanced multi-detector row computed tomography (MDCT) showed a gastric varix located in the cardia and fornix of the stomach (arrow). (b) The initial retrograde venography obtained while the balloon (arrowhead) was inflated in the gastro-renal shunt revealed two branches of the left inferior phrenic vein and the left inferior pericardiacophrenic vein (arrow), a vessel communicating with the left retro-aortic renal vein (small arrowhead), and other small veins, all of which had developed as collateral vessels. Note that the gastric varix could not be visualized. (c) Retrograde venography performed after embolization of two branches of the left inferior phrenic vein with microcoils (arrowheads) demonstrates the vessel communicating with the retro-aortic vein (arrows) and other small collateral vessels. Note that the gastric varix is still not evident. (d) Retrograde venography shows the dilated left pericardiacophrenic vein (arrows) that developed as a drainage vein after embolization of the vessel communicating with the retro-aortic vein using micro-coils (arrowhead). (e) Roentgenogram obtained after injection of sclerotic agents performed while the micro-balloon positioned in the left pericardiacophrenic vein was inflated (arrow) showed complete filling of sclerotic agents in the gastric varix (arrowheads). (f) Contrast-enhanced MDCT scan obtained 1 month after the balloon-occluded retrograde transvenous obliteration confirmed complete disappearance of enhancement in the gastric varix (arrow).
Mentions: A 62-year-old man with Child’s A class liver cirrhosis caused by hepatitis C virus infection was admitted for treatment of a large gastric varix for prevention of rupture. The patient had an earlier history of bleeding. Endoscopic examination revealed a bead-shaped moderate varix without the red color sign located at the gastric cardia and fornix. Abdominal contrast-enhanced multi-detector row computed tomography (MDCT) confirmed that the gastric varix was located in the cardia and fornix of the stomach (Fig. 1a). There was no sign of ascites. Additionally, the CT images revealed that the patient had a circumaortic venous ring.Fig. 1.

Bottom Line: We encountered a case with a gastric varix that drained into the gastro-renal shunt, left pericardiacophrenic vein, and several other dilated collateral veins.Before injection of sclerotic agents, collateral veins other than the left pericardiacophrenic vein were embolized with micro-coils.During the injection, the left pericardiacophrenic vein was occluded temporarily with a micro-balloon catheter coaxially advanced from the catheter inserted from the femoral vein to the left pericardiacophrenic vein through the left brachiocephalic vein.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.

ABSTRACT
We encountered a case with a gastric varix that drained into the gastro-renal shunt, left pericardiacophrenic vein, and several other dilated collateral veins. This patient had a circumaortic venous ring. For this case we successfully performed balloon-occluded retrograde transvenous obliteration in which sclerotic agents were infused from the balloon catheter advanced to the left pre-aortic renal vein and the tip was wedged into the end of the gastro-renal shunt. Before injection of sclerotic agents, collateral veins other than the left pericardiacophrenic vein were embolized with micro-coils. During the injection, the left pericardiacophrenic vein was occluded temporarily with a micro-balloon catheter coaxially advanced from the catheter inserted from the femoral vein to the left pericardiacophrenic vein through the left brachiocephalic vein.

No MeSH data available.


Related in: MedlinePlus