title: Combined transmesenteric and transhepatic recanalization of chronic portal and mesenteric vein occlusion to treat bleeding duodenal varices.
abstract: Two patients presented with bleeding duodenal varices secondary to mesenteric and portal vein chronic occlusion. After a failed transhepatic recanalization, a combined transmesenteric and transhepatic approach was used to recanalize the chronic portal and mesenteric venous obstruction. The occluded segment was treated with transmesenteric stent placement in one patient and stent placement and coil embolization of varices in the second patient. Follow-up imaging and endoscopy showed decompression of the duodenal varices in both patients and absence of further bleeding episodes.
authors.affiliation: Division of Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Box 800170, 1215 Lee Street, Charlottesville, VA 22908. Electronic address: ss2bp@virginia.edu.
authors.forename: Saher S
authors.initials: SS
authors.lastname: Sabri
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Virginia Health System, Box 800170, 1215 Lee Street, Charlottesville, VA 22908.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Caldwell
authors.affiliation: Department of Transplantation Surgery, University of Kansas Hospital, Kansas City, Kansas.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Kumer
authors.affiliation: Department of Transplantation Surgery, University of Kansas Hospital, Kansas City, Kansas.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Schmitt
authors.affiliation: Department of Surgery, University of Virginia Health System, Box 800170, 1215 Lee Street, Charlottesville, VA 22908.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Maluf
authors.affiliation: Division of Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Box 800170, 1215 Lee Street, Charlottesville, VA 22908.
authors.forename: John F
authors.initials: JF
authors.lastname: Angle
authors.affiliation: Division of Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Box 800170, 1215 Lee Street, Charlottesville, VA 22908.
authors.forename: Wael E
authors.initials: WE
authors.lastname: Saad
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D002908:Chronic Disease; D054893:Cone-Beam Computed Tomography; D004386:Duodenum / Q000098:blood supply*; D004621:Embolization, Therapeutic / Q000295:instrumentation; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008642:Mesenteric Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D010690:Phlebography / Q000379:methods; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D015607:Stents; D016896:Treatment Outcome; D014648:Varicose Veins / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D014654:Vascular Patency