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Gastric variceal hemorrhage treated with percutaneous transhepatic embolization with balloon-occluded antegrade transvenous obliteration

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초록

We report a case of gastric variceal hemorrhage where high model for end-stage liver disease score and the complex gastric variceal anatomy precluded the use of both transjugular intrahepatic porto-systemic shunt and standard balloon-occluded retrograde transvenous occlusion (BRTO) procedures respectively. The patient was successfully managed by percutaneous transhepatic coil embolization combined with BRTO. It is of great importance to obtain an accurate cross-sectional image to evaluate the anatomical variances of gastric varices that will lead to appropriate vascular access and to chose a suitable embolization method.

Abstract

We report a case of gastric variceal hemorrhage where high model for end-stage liver disease score and the complex gastric variceal anatomy precluded the use of both transjugular intrahepatic porto-systemic shunt and standard balloon-occluded retrograde transvenous occlusion (BRTO) procedures respectively. The patient was successfully managed by percutaneous transhepatic coil embolization combined with BRTO. It is of great importance to obtain an accurate cross-sectional image to evaluate the anatomical variances of gastric varices that will lead to appropriate vascular access and to chose a suitable embolization method.

참고문헌 (4)

  1. D’Amico G, "Upper digestive bleeding in cirrhosis. post-therapeutic outcome and prognostic indicators", Hepatology, 38, pp.599~612 (2003)
  2. Kiyosue H, "Transcatheter obliteration of gastric varices. Part 1. Anatomic classification", Radiographics, 23, pp.911~920 (2003)
  3. Ishikawa T, "Percutaneous transhepatic obliteration and percutaneous transhepatic sclerotherapy for intractable hepatic encephalopathy and gastric varices improves the hepatic function reserve", Biomed Rep, 6, pp.99~102 (2017)
  4. Tesdal IK, "Transjugular intrahepatic portosystemic shunts : adjunctive embolotherapy of gastroesophageal collateral vessels in the prevention of variceal rebleeding", Radiology, 236, pp.360~367 (2005)

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