A rare case of bleeding duodenal varices from superior mesenteric vein obstruction -treated with transhepatic recanalization and stent placement

Abstract

Ectopic varices are complex and highly variable entities that are not fully understood. Duodenal varices from pancreatitis have rarely been reported. Ectopic varices have much higher bleeding rates than the more common gastro-esophageal varices, and are associated with higher mortality. The ideal management of this difficult problem is not only to ensure prompt hemostasis, but also address the etiology or hemodynamics of the ectopic varices. We discuss the endovascular management of bleeding duodenal varices, which developed from superior mesenteric vein occlusion, following repeated attacks of pancreatitis. This unusual case was managed by a multidisciplinary collaborative approach between the gastrointestinal service and Interventional radiology. The classification system for ectopic varices and management options has been discussed in some detail. Medium term follow-up (8 months), at the time of this writing, showed that the patient is doing well, without interval hematemesis, imaging findings of recurrent/new varices or stent occlusion.

Balloon assisted stent deployment in the cephalic arch (BASCA)

“…The treatment options available for management CAS includes angioplasty, stent placement, cutting balloon angioplasty, inflow reduction, and surgeries such as cephalic vein transposition, patch angioplasty, or bypass [6] . Angioplasty with a high-pressure balloon in this location has very low patency rates with a high rate of rupture with the need for placement of a SG [9 , 18 , 19] . Additionally, studies comparing angioplasty to SGs favor higher patency rates for SGs [6 , 8 , 18 , 20] .…”

“…The cephalic arch (CA) is the most common site of stenosis in the brachiocephalic fistulas and in 15% of dysfunctional AVFs overall [4 , 5] . When considering endovascular options to treat these lesions, stent grafts (SG) have significantly higher patency rates compared to bare metal stents or just balloon angioplasty [6] , [7] , [8] , [9] , [10] .…”

Extraosseous Ewing’s Sarcoma: Pictorial Review of Imaging Findings, Differential Diagnosis, and Pathologic Correlation

“…[39][40][41][42] Lymphomas are differentiated from EES via identification of lymph node involvement; EES rarely involves lymph nodes. [43][44][45] Extraosseous mesenchymal chondrosarcomas are painless, slowly growing masses with chondroid matrix (►Fig. 11).…”

“…Lymphomas are differentiated from EES via identification of lymph node involvement; EES rarely involves lymph nodes. 43 44 45 …”

Demystifying Sacral Masses: A Pictorial Review

“…Radiographs and CT images reveal large lytic lesions with characteristic chondroid matrix-ring and arc calcification. 7 21 Calcifications are manifested as areas of signal void on all pulse sequences at MRI. On MRI the noncalcified portion is hyperintense on T2-weighted images and hypo- to isointense to skeletal muscle on T1-weighted images.…”