title: The role of divided injections of a sclerotic agent over two days in balloon-occluded retrograde transvenous obliteration for large gastric varices.
abstract: OBJECTIVE
  To determine the safety and usefulness of a two-tiered approach to balloon-occluded retrograde transvenous obliteration (B-RTO) as a treatment for large gastric varices after portal hypertension.
  
  
  METHODS
  50 patients were studied who underwent B-RTO for gastric varices between October 2004 and October 2011 in our institution. The B-RTO procedure was performed from the right femoral vein and the B-RTO catheter was retained until the following morning. Distribution of sclerotic agents in the gastric varices on fluoroscopy was evaluated in all patients on days 1 and 2. When distribution of sclerotic agents in the gastric varices on day 1 had been none or very scanty even though the volume of the sclerotic agent infused was above the acceptable level, a second infusion was administered on day 2. When distribution was satisfactory, the B-RTO catheter was removed.
  
  
  RESULTS
  In 8 (16%) patients, little or no sclerotic agent infused on day 1 was distributed in the gastric varices. However, on day 2, sclerotic agents were distributed in all gastric varices. Mean volume of ethanolamine oleate-iopamidol infused on day 1 was 24.6 mL and was 19.4 mL on day 2. Gastric varices were well obliterated with no recurrence. Complications caused by the sclerotic agent such as pulmonary edema or renal insufficiencies were not seen.
  
  
  CONCLUSIONS
  When gastric varices are very large, a strategy involving thrombosis of only the drainage vein on the first day followed by infusing the sclerotic agent on the following day might be effective and feasible.
authors.affiliation: Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan. yamagami@koto.kpu-m.ac.jp
authors.forename: Takuji
authors.initials: T
authors.lastname: Yamagami
authors.forename: Rika
authors.initials: R
authors.lastname: Yoshimatsu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miura
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Terumitsu
authors.initials: T
authors.lastname: Hasebe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000379:methods*; D002408:Catheters, Indwelling; D003097:Collateral Circulation; D004334:Drug Administration Schedule; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005260:Female; D005268:Femoral Vein; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D007479:Iopamidol / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D014057:Tomography, X-Ray Computed
chemical_list: D009829:Oleic Acids; D012597:Sclerosing Solutions; D007479:Iopamidol; C033343:ethanolamine oleate
keywords: Portal veins; Stomach, varices; Therapeutic blockade