title: Development of thrombus in a systemic vein after balloon-occluded retrograde transvenous obliteration of gastric varices.
abstract: OBJECTIVE
  To retrospectively evaluate the frequency and risk factors for developing thrombus in a systemic vein such as the infrarenal inferior vena cava or the iliac vein, in which a balloon-occluded retrograde transvenous obliteration (B-RTO) catheter was indwelled.
  
  
  METHODS
  Forty-nine patients who underwent B-RTO for gastric varices were included in this study. The B-RTO procedure was performed from the right femoral vein, and the B-RTO catheter was retained overnight in all patients. Pre- and post-procedural CT scans were retrospectively compared in order to evaluate the development of thrombus in the systemic vein in which the catheter was indwelled. Additionally, several variables were analyzed to assess risk factors for thrombus in a systemic vein.
  
  
  RESULTS
  In all 49 patients (100%), B-RTO was technically successful, and in 46 patients (94%), complete thrombosis of the gastric varices was achieved. In 6 patients (12%), thrombus developed in the infrarenal inferior vena cava or the right common-external iliac vein. All thrombi lay longitudinally on the right side of the inferior vena cava or the right iliac vein. One of the aforementioned 6 patients required anticoagulation therapy. No symptoms suggestive of pulmonary embolism were observed. Prothrombin time-international normalized ratio and the addition of 5% ethanolamine oleate iopamidol, on the second day, were related to the development of thrombus.
  
  
  CONCLUSIONS
  Development of a thrombus in a systemic vein such as the inferior vena cava or iliac vein, caused by indwelling of the B-RTO catheter, is relatively frequent. Physicians should be aware of the possibility of pulmonary embolism due to iliocaval thrombosis.
authors.affiliation: Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan. rika442@koto.kpu-m.ac.jp
authors.forename: Rika
authors.initials: R
authors.lastname: Yoshimatsu
authors.forename: Takuji
authors.initials: T
authors.lastname: Yamagami
authors.forename: Osamu
authors.initials: O
authors.lastname: Tanaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miura
authors.forename: Kotaro
authors.initials: K
authors.lastname: Okuda
authors.forename: Mitsuoki
authors.initials: M
authors.lastname: Hashiba
authors.forename: Tsunehiko
authors.initials: T
authors.lastname: Nishimura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D021721:Balloon Occlusion / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000628:therapy*; D005260:Female; D005268:Femoral Vein; D006801:Humans; D019934:International Normalized Ratio; D007479:Iopamidol / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000008:administration & dosage; D011517:Prothrombin Time; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000925:Anticoagulants; D009829:Oleic Acids; D007479:Iopamidol; C033343:ethanolamine oleate