title: Management of stomal varices with transvenous obliteration utilizing sodium tetradecyl sulfate foam sclerosis.
abstract: The management of parastomal varices is not established. Transjugular intrahepatic portosystemic shunt (TIPS) creation is the most commonly described treatment; however, the rebleed rate after TIPS is 21-37%. The purpose of the study is to determine the effectiveness of transvenous obliteration using sodium tetradecyl sulfate (STS) and to describe a new simplified technique in obliterating these varices. Four patients are presented who underwent transvenous obliteration using STS. One was obliterated using balloon occlusion from the systemic veins, the second was obliterated without balloon from a transhepatic antegrade approach, and the last two patients were obliterated using the direct antegrade technique. This simplified technique requires only a micropuncture kit (not requiring balloons or coils) and ultrasound transducer compression of the systemic draining veins, relying on high portal pressure to keep the sclerosant confined to the varices. The sclerosant is essentially trapped between the portal pressure and the ultrasound-transducer compression (10-15 min). Technical success was achieved in all four patients without procedural or postprocedural complications and no rebleeding for a mean follow-up of 17 (range 2-33) months. Transvenous obliteration of parastomal varices utilizing STS as a sclerosant is safe and effective. The newly described technique is simple, feasible, and requires minimal equipment (no balloons or coils or catheters).
authors.affiliation: Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St, PO Box 800170, Charlottesville, VA, 22908, USA, wspikes@yahoo.com.
authors.forename: Wael E A
authors.initials: WE
authors.lastname: Saad
authors.forename: Sandra
authors.initials: S
authors.lastname: Schwaner
authors.forename: Allison
authors.initials: A
authors.lastname: Lippert
authors.forename: Saher S
authors.initials: SS
authors.lastname: Sabri
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al-Osaimi
authors.forename: Alan H
authors.initials: AH
authors.lastname: Matsumoto
authors.forename: John F
authors.initials: JF
authors.lastname: Angle
authors.forename: Stephen
authors.initials: S
authors.lastname: Caldwell
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D003097:Collateral Circulation; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D006801:Humans; D007081:Ileostomy; D008297:Male; D008875:Middle Aged; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D015911:Sclerotherapy / Q000379:methods*; D012981:Sodium Tetradecyl Sulfate / Q000627:therapeutic use*; D018084:Ultrasonography, Interventional
chemical_list: D012597:Sclerosing Solutions; D012981:Sodium Tetradecyl Sulfate