Direct percutaneous access to a mesenteric vein for antegrade embolization of esophageal varices: A case report

Abstract

A 79-year-old woman with a history of advanced gastric cancer and portal vein tumor thrombus, treated with surgery and chemoradiotherapy, presented with hematemesis due to esophageal variceal bleeding around the esophagojejunal anastomosis. Endoscopic treatment was unsuccessful. Due to portal vein occlusion, percutaneous transhepatic access was difficult. Thus, the middle colic vein, which was dilated due to portal vein occlusion, was percutaneously punctured, and antegrade embolization of a jejunal vein feeding the varices was performed using a microcatheter through a 4-F dilator placed as a sheath. After embolization, the sheath was removed, and ultrasound-guided compression of the puncture site was performed. No bleeding complication occurred. Therefore, direct percutaneous access to a mesenteric vein is a viable alternative to transhepatic access.

Embolisation of the parenchymal tract after percutaneous portal vein catheterization: a retrospective comparison of outcomes with different techniques in two centres

“…We suggest using a Lipiodol/glue ratio lower that 3 to obtain rapid polymerization and prevent non-target embolisation. The performance of other devices proposed for PVCC, in particular, plugs (Dollinger et al 2013 ), vascular closure kits (Tan et al 2020 ), and microfibrillar collagen paste (Gaba et al 2017 ), was not assessed, as was the recently described PVCC via the mesenteric vein (Onishi et al 2021 ).…”

Direct percutaneous access to an omental vein for embolization of Roux-en-Y limb varices in a child

“…Direct percutaneous access to the portal venous system is not widely known, and a small number of case series and case reports have reported the usefulness of direct access to the portal venous system [7] , [8] , [9] , [10] , [11] . When direct access is performed, hemostasis at the puncture site becomes the problem.…”

“…When direct access is performed, hemostasis at the puncture site becomes the problem. Previous reported methods of puncture site hemostasis were tract embolization using NBCA mixed with lipiodol [ 7 , 8 ], usage of a closure device [9] , and manual compression [11] . Manual compression is the most basic and simple method of hemostasis, and we used this method because ultrasonography confirmed that the vein was compressible.…”

Embolization of the parenchymal tract after percutaneous portal vein catheterization: a retrospective comparison of outcomes with different techniques in two centers.

“…We suggest using a lipiodol/glue ration lower that 3 to obtain a rapid polymerization and prevent non-target embolization. The performance of other devices proposed for PVCC, in particular, plugs [5], vascular closure kits [12], and micro brillar collagen paste [13], was not assessed, as was the recently described PVCC via the mesenteric vein [14].…”