title: Ruptured high flow gastric varices with an intratumoral arterioportal shunt treated with balloon-occluded retrograde transvenous obliteration during temporary balloon occlusion of a hepatic artery.
abstract: A patient presented with hematemesis due to gastric variceal bleeding with an intratumoral arterioportal shunt. Contrast-enhanced CT revealed gastric varices and hepatocellular carcinoma with tumor thrombi in the right portal vein. Angiography and angio-CT revealed a marked intratumoral arterioportal shunt accompanied with reflux into the main portal vein and gastric varices. Balloon-occluded retrograde venography from the gastro-renal shunt showed no visualization of gastric varices due to rapid blood flow through the intratumoral arterioportal shunt. The hepatic artery was temporarily occluded with a balloon catheter to reduce the blood flow through the arterioportal shunt, and then concurrent balloon-occluded retrograde transvenous obliteration (BRTO) was achieved. Vital signs stabilized immediately thereafter, and contrast-enhanced CT revealed thrombosed gastric varices. Worsening of hepatic function was not recognized. BRTO combined with temporary occlusion of the hepatic artery is a feasible interventional procedure for ruptured high flow gastric varices with an intratumoral arterioportal shunt.
authors.affiliation: Department of Radiology, Hidaka General Hospital 116-2 Sono, Gobo Shi, Wakayama 644-8655, Japan. nakai@hidakagh.gobo.wakayama.jp
authors.forename: Motoki
authors.initials: M
authors.lastname: Nakai
authors.forename: Morio
authors.initials: M
authors.lastname: Sato
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Tanihata
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Sonomura
authors.forename: Shinya
authors.initials: S
authors.lastname: Sahara
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kawai
authors.forename: Masashi
authors.initials: M
authors.lastname: Kimura
authors.forename: Masaki
authors.initials: M
authors.lastname: Terada
mesh_terms: D000368:Aged; D000792:Angiography; D021721:Balloon Occlusion / Q000379:methods*; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation; D004932:Esophageal and Gastric Varices / Q000175:diagnosis*; D006499:Hepatic Artery / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D014057:Tomography, X-Ray Computed / Q000379:methods