Balloon-occluded retrograde transvenous obliteration of gastric varices: use of CT-guided foam sclerotherapy to optimize technique.
OBJECTIVE
Balloon-occluded retrograde transvenous obliteration has been traditionally based on liquid sclerotherapy. However, overdose and systemic spillage of liquid sclerosant can cause severe complications, such as hemolysis, which lead to hemoglobinuria, allergy, acute respiratory distress syndrome, and other disorders. The purpose of this study was to evaluate the performance of foam sclerotherapy with C-arm CT guidance to reduce the amount of sclerosant and to optimize the safety of balloon-occluded retrograde transvenous obliteration while preserving its efficacy.


METHODS
Twenty consecutively registered patients with gastric varices underwent balloon-occluded retrograde transvenous obliteration with polidocanol foam. C-arm CT guidance was used to confirm gas filling of the target vessels. In this retrospective analysis of a prospectively encoded database, total net doses of polidocanol used for transvenous obliteration and of contrast medium used for venography before transvenous obliteration were compared, and subsequent complications, including hemoglobinuria, were documented.


RESULTS
In all patients, foam was observed in the target vessels at C-arm CT. The mean dose of polidocanol used for balloon-occluded retrograde transvenous obliteration (3.9 ± 1.5 mL) was significantly smaller (p < 0.001) than the dose of contrast medium used for venography (16.4 ± 7.9 mL). Hemoglobinuria was found in only one patient. Except in one instance of recanalization, full variceal thrombosis was confirmed at contrast-enhanced CT 1 week after transvenous obliteration (success rate, 95%). In one patient, air migrated into the liver during transvenous obliteration but was spontaneously absorbed. No serious complication occurred.


CONCLUSIONS
Balloon-occluded retrograde transvenous obliteration with polidocanol foam under C-arm CT guidance allowed significant reduction of sclerosant dose and resulted in a low complication rate while a high technical success rate and efficacy were maintained.
Department of Diagnostic Radiology, School of Medicine, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193 Japan. jkoizumi@is.icc.u-tokai.ac.jp
Jun
J
Koizumi
Takeshi
T
Hashimoto
Kazunori
K
Myojin
Chihiro
C
Itou
Tatehiro
T
Kagawa
Toshiya
T
Nishibe
Bertrand
B
Janne d'Othée
D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000009:adverse effects / Q000379:methods*; D003287:Contrast Media; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D006456:Hemoglobinuria / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D003287:Contrast Media; D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols