Gastric Varices and Hepatic Encephalopathy: Treatment with Vascular Plug and Gelatin Sponge–assisted Retrograde Transvenous Obliteration—A Primary Report

Gwon, Dong Il; Ko, Gi Young; Yoon, Hyun Ki; Sung, Kyu Bo; Kim, Jin Hyoung; Shin, Ji Hoon; Ko, Heung Kyu; Song, Ho Young

doi:10.1148/radiol.13122102

Cited by 81 publications

(116 citation statements)

References 25 publications

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“…Gwon et al (15) reported that follow-up CT within 1 week after PARTO showed complete thrombosis of both gastric varices and gastrorenal shunts in all patients, and a 2-month followup CT showed complete obliteration. Our study also demonstrated complete occlusion of the gastric varices and gastrorenal shunts in all 14 patients who underwent PARTO, which was confirmed by the 1-month follow-up CT.…”

Section: Discussionmentioning

confidence: 95%

“…Resorption of these agents causes temporary occlusion, and subsequent recanalization can occur within a few weeks (15). Lubarsky et al (20) reported that vessels embolized with gelfoam typically recanalize in several weeks.…”

Section: Discussionmentioning

confidence: 99%

“…The indwelling time of the occlusion balloon varies from 30 min to overnight (7,15,20,23) with prominent secondary shunts (type C) detected on preprocedural CT were not considered as candidates for PARTO in our study. Furthermore, small collaterals and portosystemic shunts can be more difficult to assess fully by imaging (7).…”

Section: Discussionmentioning

confidence: 99%

“…Gwon et al (15) reported a variant of BRTO, vascular plugassisted retrograde transvenous obliteration (PARTO), to overcome the drawbacks of BRTO using sclerosant by PARTO is an alternative endovascular treatment that uses a vascular plug and gelatin sponge particles instead of balloon occlusion of the gastrorenal shunt and a sclerosing agent. However, gelatin sponge is an absorbable agent that produces a temporary occlusion when used for gastric variceal embolization, leading to a greater likelihood of recanalization, as compared with a permanent agent such as EO.…”

Section: Balloon-occluded Retrograde Transvenous Obliteration (Brto)mentioning

confidence: 99%

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Vascular Plug-Assisted Retrograde Transvenous Obliteration for the Management of Gastric Varices: Comparative Effectiveness between Gelatin Sponge Embolization and Permanent Sclerosant

Lee

Park

et al. 2016

J Korean Soc Radiol

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Purpose:To evaluate the short-term outcome of plug-assisted retrograde transvenous obliteration (PARTO) using vascular plugs and gelatin sponges in comparison with balloon-occluded retrograde transvenous obliteration (BRTO) for the management of gastric varices. Materials and Methods: From January 2005 to October 2014, 171 patients were referred for management of gastric varices, of which, 52 patients with hemodynamically stable gastric varices (48 recent bleeding; 4 primary prophylaxes) were evaluated. Of these, 38 received BRTO (men/women 23/15; mean age 61.3; Child-Pugh classes A/B/C = 11/25/2) and 14 underwent PARTO (men/women 11/3; mean age 63.4; ChildPugh classes A/B/C = 9/4/1). The technical success rate, complications, variceal changes, liver function, and exacerbation of ascites/pleural effusion were compared between the 2 groups within 3 months after the procedure. Results: The technical success rates were 92.1% in the BRTO and 100% in the PARTO group. Procedure-related early complications occurred in the BRTO group alone (8%, n = 3). Among patients with technical success, follow-up CT at 1 month was available for 98% (n = 48/49). Complete thrombosis of gastric varices was achieved in 97.1% in the BRTO and 100% in the PARTO group. Worsening of esophageal varices was observed in 24% of the BRTO group alone (n = 8). The albumin level increased significantly in both groups and aspartate aminotransferase/alanine aminotransferase level improved significantly in the PARTO group (p < 0.05). Exacerbation of ascites/pleural effusion was observed in both groups (35.2% vs. 21.4%, both p > 0.05). Conclusion: PARTO appears to be equivalent to BRTO for short-term management of gastric varices.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Balloon-occluded Retrograde Transvenous Obliteration (Brto)mentioning

confidence: 99%

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Vascular Plug-Assisted Retrograde Transvenous Obliteration for the Management of Gastric Varices: Comparative Effectiveness between Gelatin Sponge Embolization and Permanent Sclerosant

Lee

Park

et al. 2016

J Korean Soc Radiol

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“…Although a vascular plug is relatively expensive, it may reduce the number of coils needed, thereby potentially saving both time and reducing costs [28]. Hence, plug-assisted retrograde transvenous obliteration (PARTO) is a therapeutic option for HE caused by portosystemic shunts [30,31].…”

Section: ]mentioning

confidence: 99%

Efficacy and Safety of Transcatheter Embolization for Hepatic Encephalopathy Caused by Spontaneous Portosystemic Shunts

Takenaga

Aizawa

2017

Interventional Radiology

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Hepatic encephalopathy (HE) is a syndrome that occurs in patients with severe liver dysfunction or a portosystemic shunt. In patients with refractory HE caused by a portosystemic shunt, interventional closure of the shunt vessel is essential. Currently, transcatheter embolization is recognized as a less invasive and highly effective procedure, and it is considered as a first-choice method for the occlusion of shunt vessels. In this review, we discuss the role of a portosystemic shunt in the development of HE and describe the procedure and significance of transcatheter embolization of a portosystemic shunt.

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Management Options for Gastric Variceal Hemorrhage

et al. 2019

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irrhosis is a serious complication of liver disease and is commonly caused by viral hepatitis and alcohol consumption. 1,2 Cirrhosis causes abnormal cellular alterations, which increase vascular resistance through the liver. Cirrhosis also comes with cellular damage, tissue fibrosis, liver hardening, nodule formation, and sinusoidal remodeling. Damage to the hepatocytes also results in a disruption of the normal equilibrium between vasodilators and vasoconstrictors and increases total blood flow into the portal system. Endogenous vasodilators such as nitric oxide increase the amount of blood flowing into the portal system by inducing splanchnic arteriolar vasodilation. Following the Ohm law, an increase in vascular resistance along with an increase in portal inflow results in an increase in portal pressure. Subsequently, cirrhosis results in clinical manifestations of portal hypertension.Owing to the variability in severity and progression, cirrhosis is commonly classified into 2 stages: compensated and decompensated. Decompensated cirrhosis is more severe and results in major complications such as ascites, jaundice, encephalopathy and variceal hemorrhage. 1,2 Thus, it is imperative to monitor the progression of compensated cirrhosis and pay close attention to predictive markers of worsening portal hypertension, such as the hepatic venous pressure gradient (HVPG). An HVPG of 10 mm Hg or more is highly

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Gastric Varices and Hepatic Encephalopathy: Treatment with Vascular Plug and Gelatin Sponge–assisted Retrograde Transvenous Obliteration—A Primary Report

Abstract: Vascular plug-assisted RTO is technically simple and safe and seems to be clinically effective for treatment of GV and HE.

Cited by 81 publications

References 25 publications

Vascular Plug-Assisted Retrograde Transvenous Obliteration for the Management of Gastric Varices: Comparative Effectiveness between Gelatin Sponge Embolization and Permanent Sclerosant

Vascular Plug-Assisted Retrograde Transvenous Obliteration for the Management of Gastric Varices: Comparative Effectiveness between Gelatin Sponge Embolization and Permanent Sclerosant

Efficacy and Safety of Transcatheter Embolization for Hepatic Encephalopathy Caused by Spontaneous Portosystemic Shunts

Management Options for Gastric Variceal Hemorrhage

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