Coil-Assisted Retrograde Transvenous Obliteration (CARTO) for the Treatment of Portal Hypertensive Variceal Bleeding: Preliminary Results

Lee, Edward W.; Saab, Sammy; Gomes, Antoinette S.; Busuttil, Ronald W.; McWilliams, J.; Durazo, Francisco; Han, Steven‐Huy B.; Goldstein, Leonard I.; Tafti, Bashir Akhavan; Moriarty, John M.; Loh, Christopher; Kee, Stephen T.

doi:10.1038/ctg.2014.12

Cited by 93 publications

(128 citation statements)

References 37 publications

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“…As reported, this modified BRTO may acquire better curative effect in the treatment of gastric varices due to portal hypertension. 34,35 So, it was imaginable that BRTO was not only a simple surgery, but also a therapeutic direction in the management of gastric varices due to portal hypertension. Note: *Means that the associated data could not be acquired from the original article or the author.…”

Section: Discussionmentioning

confidence: 98%

Balloon‐occluded retrograde transvenous obliteration versus transjugular intrahepatic portosystemic shunt for treatment of gastric varices due to portal hypertension: A meta‐analysis

Wang

Zhang

Gong

et al. 2016

J of Gastro and Hepatol

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Section: Discussionmentioning

confidence: 98%

Balloon‐occluded retrograde transvenous obliteration versus transjugular intrahepatic portosystemic shunt for treatment of gastric varices due to portal hypertension: A meta‐analysis

Wang

Zhang

Gong

et al. 2016

J of Gastro and Hepatol

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“…Lee et al . introduced CARTO in 2012 and reported 20 cases of the procedure in 2014 . They reported the technical success rate of 100%.…”

Section: Modified Balloon‐occluded Retrograde Transvenous Obliteratiomentioning

confidence: 99%

Recent development of balloon‐occluded retrograde transvenous obliteration

Kobayakawa

Ohnishi

Suzuki

2018

J of Gastro and Hepatol

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Gastric varices (GVs) are a major complication of portal hypertension in patients with liver cirrhosis. The mortality rate associated with the bleeding from GVs is not low. Balloon-occluded retrograde transvenous obliteration (BRTO) was first introduced by Kanagawa et al. as a treatment for isolated GVs in 1994. It has been performed most frequently in Asia, especially in Japan. Ethanolamine oleate was the original sclerosant used in the therapy. Since the late 2000s, BRTO using sodium tetradecyl sulfate foam or polidocanol foam as a sclerosant has been performed in many countries other than Japan. Then, early in the 2010s, modified BRTO techniques including vascular plug-assisted retrograde transvenous obliteration and coil-assisted retrograde transvenous obliteration were developed as an alternative treatment for GVs. This article provides a historical overview of BRTO using various sclerosants and modified BRTO techniques, such as plug-assisted retrograde transvenous obliteration and coil-assisted retrograde transvenous obliteration.

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“…CARTO uses a coil for vascular occlusion which avoids some of the complications and difficulties associated with indwelling balloon catheters (5). In this case, it was not feasible to advance the balloon catheter into the efferent vein because of vascular tortuosity.…”

Section: Discussionmentioning

confidence: 99%

Coil-assisted retrograde transvenous obliteration for the treatment of duodenal varix

Lee

Jeon

2018

Diagn Interv Radiol

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Duodenal variceal bleeding is a rare complication of portal hypertension; although it only occurs in 0.4% of cases, it is often catastrophic because of the difficulties in diagnosis and treatment (1). Endoscopic therapy is usually the initial treatment option for bleeding duodenal varices, but it is not always feasible or successful (2). In such circumstances, endovascular treatment could be considered as an alternative option for duodenal variceal bleeding (2). Several studies reported successful results with transjugular intrahepatic portosystemic shunts (TIPS), balloon-occluded retrograde transvenous obliteration (BRTO), and percutaneous transhepatic obliteration (PTO) in treatment of duodenal varices (2-4). To the best of our knowledge, only one case of coil-assisted retrograde transvenous obliteration (CARTO), which is a modified version of BRTO using coils and gelfoam, has been reported for duodenal varix treatment without documentation of collateral pathway (5). Herein we report a case of duodenal varices originating from the inferior pancreaticoduodenal vein and draining into the right ovarian vein that was successfully embolized with coils and gelfoam using double microcatheters. TechniqueA 79-year-old female with a history of right hepatic lobectomy for intrahepatic cholangiocarcinoma presented with hematochezia. An emergency endoscopy showed tortuous blue varices with a cherry red spot in the third portion of the duodenum, suggesting a recent bleeding episode. The varices were not amenable to band ligation or endoscopic injection sclerotherapy due to their location and extent. Contrast-enhanced computed tomography (CT) revealed duodenal varices with markedly dilated veins at the third portion of the duodenum (Fig. 1a). The inferior pancreaticoduodenal vein (one of tributary of superior mesenteric vein) was the feeder of the duodenal varices, and the right ovarian vein was detected as an efferent vein (Fig. 1b).After obtaining informed consent, we initially planned retrograde venous approach via right ovarian vein to perform BRTO. Procedure was performed in the angiography suite under intravenous sedation and local anesthesia. After obtaining right internal jugular access with micropuncture access set (Cook Medical), 9 F Flexor RTPS guiding sheath (Cook Medical) was advanced to the inferior vena cava. After selection of the right ovarian vein with 5 F Torcon NB (C2) catheter (Cook Medical), we tried to advance occlusion balloon catheter into draining vein deep enough to avoid injecting sclerosing agent into a non-target vessel. However, 5 F catheter and 0.035-inch guidewire (Radiofocus, Terumo) could not be advanced into the distal efferent vein because of severe vascular tortuosity. Therefore, we ABSTRACTDuodenal variceal bleeding is a rare but potentially life-threatening complication of portal hypertension. Endoscopic therapy is usually the initial treatment option for bleeding duodenal varices, but it is not always feasible or successful. We present a technique of coil-assisted retrograde transven...

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Coil-Assisted Retrograde Transvenous Obliteration (CARTO) for the Treatment of Portal Hypertensive Variceal Bleeding: Preliminary Results

Cited by 93 publications

References 37 publications

Balloon‐occluded retrograde transvenous obliteration versus transjugular intrahepatic portosystemic shunt for treatment of gastric varices due to portal hypertension: A meta‐analysis

Balloon‐occluded retrograde transvenous obliteration versus transjugular intrahepatic portosystemic shunt for treatment of gastric varices due to portal hypertension: A meta‐analysis

Recent development of balloon‐occluded retrograde transvenous obliteration

Coil-assisted retrograde transvenous obliteration for the treatment of duodenal varix

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