title: Management of gastric varices in the pediatric population with balloon-occluded retrograde transvenous obliteration (BRTO) utilizing sodium tetradecyl sulfate foam sclerosis with or without partial splenic artery embolization.
abstract: It is unknown whether spontaneous gastrorenal shunts actually develop in the pediatric population. The minimum age documented in studies from Asia is 32 (range 32-44) years. This study describes three pediatric patients undergoing balloon-occluded retrograde transvenous obliteration (BRTO) for bleeding gastric varices with two of the three patients undergoing combined partial splenic embolization. The first BRTO is a selective-BRTO via a surgical splenorenal shunt (15 years old) and the other two patients underwent conventional-BRTO via a spontaneous gastrorenal shunt (8 and 14 years old). The recurrent significant bleeding that they exhibited before the combined endovascular therapy did not recur for an average of 7.1 (range 1.4-14) months. In the second patient, quantitative digitally subtracted angiography was utilized to evaluate the inline portal venous flow before and after BRTO.
authors.affiliation: Department of Radiology, Division of Vascular Interventional Radiology, University of Virginia Health System, 1215 Lee Street, PO Box 800170, Charlottesville, VA, 22908, USA, wspikes@yahoo.com.
authors.forename: Wael E A
authors.initials: WE
authors.lastname: Saad
authors.forename: Curtis L
authors.initials: CL
authors.lastname: Anderson
authors.forename: Rahul S
authors.initials: RS
authors.lastname: Patel
authors.forename: Sandra
authors.initials: S
authors.lastname: Schwaner
authors.forename: Stephen
authors.initials: S
authors.lastname: Caldwell
authors.forename: Shawn
authors.initials: S
authors.lastname: Pelletier
authors.forename: John
authors.initials: J
authors.lastname: Angle
authors.forename: Alan H
authors.initials: AH
authors.lastname: Matsumoto
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Fischman
mesh_terms: D000293:Adolescent; D015901:Angiography, Digital Subtraction; D021721:Balloon Occlusion; D002648:Child; D004621:Embolization, Therapeutic; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D015641:Radiography, Interventional; D012008:Recurrence; D015911:Sclerotherapy; D012981:Sodium Tetradecyl Sulfate / Q000008:administration & dosage / Q000627:therapeutic use; D013157:Splenic Artery / Q000000981:diagnostic imaging; D016896:Treatment Outcome
chemical_list: D012981:Sodium Tetradecyl Sulfate