title: Endovascular obliteration of bleeding duodenal varices in patients with liver cirrhosis.
abstract: The purpose of this paper is to describe our experience with endovascular obliteration of duodenal varices in patients with liver cirrhosis and portal hypertension. Balloon-occluded transvenous retrograde and percutaneous transhepatic anterograde embolizations were performed for duodenal varices in five patients with liver cirrhosis, portal hypertension, and decreased liver function. All patients had undergone previous endoscopic treatments that failed to stop bleeding and were poor surgical candidates. Temporary balloon occlusion catheters were used to achieve accumulation of an ethanolamine oleate-iopamidol mixture inside the varices. Elimination of the varices was successful in all patients. Retrograde transvenous obliteration via efferent veins to the inferior vena cava was enough to achieve adequate sclerosant accumulation in three patients. A combined anterograde-retrograde embolization was used in one patient with balloon occlusion of afferent and efferent veins. Transhepatic embolization through the afferent vein was performed in one patient under balloon occlusion of both efferent and afferent veins. There was complete variceal thrombosis and no bleeding was observed at follow-up. No major complications were recorded. Endovascular obliteration of duodenal varices is a feasible and safe alternative procedure for managing patients with portal hypertension and hemorrhage from this source.
authors.affiliation: Department of Radiology, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe-shi, Hyogo-ken, 650-0017, Japan. armando@med.kobe-u.ac.jp
authors.forename: Carlos Armando
authors.initials: CA
authors.lastname: Zamora
authors.forename: Koji
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Tsurusaki
authors.forename: Kenta
authors.initials: K
authors.lastname: Izaki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fukuda
authors.forename: Shinichi
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Kuwata
authors.forename: Ryota
authors.initials: R
authors.lastname: Kawasaki
authors.forename: Takanori
authors.initials: T
authors.lastname: Taniguchi
authors.forename: Shozo
authors.initials: S
authors.lastname: Hirota
authors.forename: Kazuro
authors.initials: K
authors.lastname: Sugimura
mesh_terms: D000368:Aged; D021721:Balloon Occlusion / Q000009:adverse effects / Q000379:methods*; D002404:Catheterization / Q000379:methods; D004386:Duodenum / Q000098:blood supply*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006242:Haptoglobins / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D007479:Iopamidol / Q000008:administration & dosage / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000008:administration & dosage / Q000627:therapeutic use; D012597:Sclerosing Solutions / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D014648:Varicose Veins / Q000150:complications / Q000628:therapy*
chemical_list: D006242:Haptoglobins; D009829:Oleic Acids; D012597:Sclerosing Solutions; D007479:Iopamidol; C033343:ethanolamine oleate