Percutaneous transhepatic embolization of gastroesophageal varices: results in 400 patients

L’Herminé, C; Chastanet, P; Delemazure, O; Bonnière, P; Durieu, J; Paris, J. C.

doi:10.2214/ajr.152.4.755

Cited by 60 publications

(25 citation statements)

References 1 publication

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“…Finally, embolization, whether through the percutaneous transhepatic 33,34 or the transjugular route, 35 can be performed. However, because portal hypertension is not relieved, rebleeding rates after embolization are reported to be greater than 60%.…”

Section: Discussionmentioning

confidence: 99%

“…However, because portal hypertension is not relieved, rebleeding rates after embolization are reported to be greater than 60%. [33][34][35] Hemostasis was obtained by TIPS insertion in 18 out of 20 (90%) actively bleeding patients. In the 2 patients who continued to bleed after TIPS, hemostasis was finally obtained within 48 hours using endoscopic sclerotherapy in 1 case, and occurred spontaneously in the other case.…”

Section: Discussionmentioning

confidence: 99%

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Transjugular intrahepatic portosystemic shunt in the treatment of refractory bleeding from ruptured gastric varices

Barange¹,

Péron²,

Imani³

et al. 1999

Hepatology

168

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The optimal management of ruptured gastric varices in patients with cirrhosis has not been codified yet. The present study reports the use of transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory gastric variceal bleeding. Thirty-two consecutive patients were included. All had been unresponsive to vasoactive agents infusion, sclerotherapy, and/or tamponade and were considered poor surgical candidates. They were followed-up until death, transplantation, or at least 1 year (median: 509 days; range 4 to 2,230). Hemostasis was achieved in 18 out of 20 patients actively bleeding at the time of the procedure. In the whole sample of 32 patients, rebleeding rates were 14%, 26%, and 31%, respectively at 1 month, 6 months, and 1 year. De novo encephalopathy was observed in 5 (16%) patients. Seven patients experienced complications and consequently 4 of these patients died. TIPS primary patency rates were 84%, 74%, and 51%, respectively, at 1 month, 6 months, and 1 year. For the same periods of time, survival rates were 75%, 62%, and 59%. These results suggest that TIPS can be used in cirrhotic patients with refractory gastric variceal bleeding and are effective in achieving hemostasis as well as in preventing rebleeding. (HEPATOLOGY 1999;30:1139-1143.)In the absence of any specific controlled trial the management of bleeding gastric varices in patients with cirrhosis is still a difficult problem. These bleedings are generally considered more severe than those originating from ruptured esophageal varices and more prone to relapse. 1 Transjugular intrahepatic portosystemic shunt (TIPS) has been extensively used within the last 10 years. It allows decompression of the portal system through a percutaneous approach and has consequently been used to treat both ascites 2 and variceal bleeding. [3][4][5][6][7][8][9][10]

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Transjugular intrahepatic portosystemic shunt in the treatment of refractory bleeding from ruptured gastric varices

Barange¹,

Péron²,

Imani³

et al. 1999

Hepatology

168

View full text Add to dashboard Cite

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“…16 Besides, PTO seems hardly applicable in patients with massive ascites. 16,17 Moreover, the procedure may sometimes be complicated by intraperitoneal bleeding from the liver surface. 18 Direct endoscopic injection sclerotherapy (EIS), using ethanolamine oleate, for gastric varices has been reported by other institutions.…”

Section: Discussionmentioning

confidence: 99%

Emergency balloon-occluded retrograde transvenous obliteration for gastric varices

et al. 2005

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“…However, 37%-65% of these patients presented again with recurrent bleeding as PTE only addresses variceal bleed but not PHT per se [42][43][44][45] . PTE is used to treat acute variceal bleed if it cannot be localized by endoscopy or are resistant to treatment by endoscopic means [46][47][48] .…”

Section: Percutaneous Transhepatic/trans-splenic Variceal Embolizationmentioning

confidence: 99%

Imaging and radiological interventions in extra-hepatic portal vein obstruction

Pargewar¹,

Desai²,

Rajesh³

et al. 2016

WJR

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Extrahepatic portal vein obstruction (EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension (PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt (PSS) and revision of PSS. Core tip: The present review describes the etiopathogenesis and role of imaging modalities in Extrahepatic portal vein obstruction and role of various radiological interventional procedures in its management. Pargewar SS et al . Imaging and interventions in EHPVOThe advantages and potential limitations of each imaging modality namely endoscopic retrograde cholangiography, ultrasonography and Doppler, multidetector computed tomography, magnetic resonance cholangiography and portovenography, endoscopic ultrasound and ultrasound transient elastography are discussed. Also, the concepts behind the use of interventional procedures like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, splenic artery aneurysmal embolization, balloon occluded retrograde obliteration of portosystemic shunt, etc. , are described.

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Percutaneous transhepatic embolization of gastroesophageal varices: results in 400 patients

Cited by 60 publications

References 1 publication

Transjugular intrahepatic portosystemic shunt in the treatment of refractory bleeding from ruptured gastric varices

Transjugular intrahepatic portosystemic shunt in the treatment of refractory bleeding from ruptured gastric varices

Emergency balloon-occluded retrograde transvenous obliteration for gastric varices

Imaging and radiological interventions in extra-hepatic portal vein obstruction

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