title: Anatomic features and retrograde transvenous obliteration of duodenal varices associated with mesocaval collateral pathway.
abstract: OBJECTIVE
  To evaluate techniques and efficacy of retrograde transvenous obliteration for the treatment of duodenal varices associated with mesocaval collateral pathway.
  
  
  METHODS
  Six consecutive cases of large/growing or ruptured duodenal varices treated by retrograde transvenous obliteration were retrospectively reviewed. Selective balloon-occluded retrograde transvenous obliteration (B-RTO) with 5% ethanolamine oleate (EO) was performed in all cases. When EO could not be sufficiently stagnated in the varices, additional/alternative techniques were performed, including coil embolization of afferent vein or intravariceal injection of n-butyl-2-cyanoacrylate (NBCA). Clinical findings, anatomic features of duodenal varices, obliteration techniques, complications, posttherapeutic computed tomography (CT) findings, and follow-up endoscopic findings were investigated.
  
  
  RESULTS
  All duodenal varices were located at the second/third junction of the duodenum and were fed by single (n = 1) or multiple (n = 5) pancreaticoduodenal veins. One varix fed by a single afferent vein was successfully treated by simple selective B-RTO technique alone. The other five cases required coil embolization of afferent vein (n = 1) or intravariceal injection of NBCA (n = 4) because sclerosant was not sufficiently stagnated in the varices. CT 1 week after the procedure showed complete occlusion of the varices in all cases. A duodenal ulcer at the variceal site developed in one patient and was successfully treated by medication. Follow-up endoscopy showed disappearance of varices in all cases, and no recurrence was observed during follow-up.
  
  
  CONCLUSIONS
  Retrograde transvenous obliteration is an effective technique for the treatment of duodenal varices. However, additional/alternative techniques are required for successful treatment because of the complex anatomic features of duodenal varices.
authors.affiliation: Department of Radiology, Faculty of Medicine, Oita University, Yufu-shi, Oita, Japan. okahara@oita-u.ac.jp
authors.forename: Mika
authors.initials: M
authors.lastname: Okahara
authors.forename: Hiro
authors.initials: H
authors.lastname: Kiyosue
authors.forename: Sinya
authors.initials: S
authors.lastname: Ueda
authors.forename: Junji
authors.initials: J
authors.lastname: Kashiwagi
authors.forename: Shuichi
authors.initials: S
authors.lastname: Tanoue
authors.forename: Norio
authors.initials: N
authors.lastname: Hongo
authors.forename: Hiromu
authors.initials: H
authors.lastname: Mori
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000009:adverse effects / Q000379:methods*; D003097:Collateral Circulation; D004384:Duodenoscopy; D004386:Duodenum / Q000098:blood supply*; D004621:Embolization, Therapeutic; D004659:Enbucrilate / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000008:administration & dosage; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage; D013152:Splanchnic Circulation; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014648:Varicose Veins / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*
chemical_list: D009829:Oleic Acids; D012597:Sclerosing Solutions; D004659:Enbucrilate; C033343:ethanolamine oleate