Utility of Coil-Assisted Retrograde Transvenous Obliteration II (CARTO-II) for the Treatment of Gastric Varices

Abstract

Purpose To investigate the technical feasibility, safety and clinical outcomes of coil-assisted retrograde transvenous obliteration II (CARTO-II) for gastric varices (GV). Materials and Methods Thirty-six consecutive patients who had undergone CARTO-II between June 2016 and April 2018 were included in the study. In the CARTO procedure, coil embolization of the drainage vein is performed ''before'' injection of the sclerosant to replace the use of balloon catheter. In the CARTO-II procedure, coil embolization of the drainage vein was performed ''after'' injection of the sclerosant to prevent migration of the sclerosant. CARTO-II was performed with ethanolamine oleate iopamidol, and the balloon catheter was immediately removed after coil placement. Technical and clinical success rates, number of coils used, presence or absence of severe complications, timing of the procedure, and rate of GV recurrence after the procedure were analyzed retrospectively. Results In all patients, GV sclerosis, coil placement and removal of the balloon catheter were successfully completed. The technical success rate was 100%. No patients experienced severe complications such as coil migration or pulmonary embolization. The mean number of metallic coils used per procedure was 3.36. Mean length of the procedure was 132.8 min. Contrast-enhanced computed tomography after CARTO-II confirmed complete variceal thrombosis in all cases. The recurrence rate of GV during follow-up was 2.8% (mean follow-up, 207 days). Conclusion CARTO-II was feasible and safe and could be performed relatively quickly. The number of coils used and the rate of GV recurrence were both low. CARTO-II may have an important role to play in the management of GV.

Usefulness of coil-assisted retrograde transvenous obliteration II (CARTO-II) for the treatment of ascending colonic varix: a case report

“…In the present case, only two microcoils were used to embolize the draining vein, and it took less than 2 h to complete the procedure using CARTO-II. With respect to the number of coils used and the procedure length, this case was similar to the previous study of CARTO-II (Yamamoto et al 2020). Figure 2a shows that the draining vein was very tortuous and long to reach near the varix.…”

“…Recently, modified versions of B-RTO have been developed, such as CARTO and plug-assisted retrograde transvenous obliteration (PARTO) (Lee et al 2014 ; Gwon et al 2013 ). CARTO procedure has two subtypes: CARTO or CARTO-I, and CARTO-II (Kim et al 2018 ; Yamamoto et al 2020 ). In CARTO, coil embolization of the draining vein is performed first, prior to injection of sclerosant, without balloon occlusion, whereas in CARTO-II, coil embolization of the draining vein is performed after injection of sclerosant under balloon occlusion.…”

“…In CARTO, coil embolization of the draining vein is performed first, prior to injection of sclerosant, without balloon occlusion, whereas in CARTO-II, coil embolization of the draining vein is performed after injection of sclerosant under balloon occlusion. The balloon catheter is finally deflated and removed after the procedure in CARTO-II (Yamamoto et al 2020 ). A recent study of CARTO-II demonstrated that this modified technique has two advantages compared to the original CARTO: keeping cost down and saving time (Yamamoto et al 2020 ).…”

“…The balloon catheter is finally deflated and removed after the procedure in CARTO-II (Yamamoto et al 2020 ). A recent study of CARTO-II demonstrated that this modified technique has two advantages compared to the original CARTO: keeping cost down and saving time (Yamamoto et al 2020 ). One advantage derives from the use of a smaller number of coils than CARTO, the other from the lack of any need to wait for complete occlusion before injecting sclerosants.…”

“…3 b), the sclerosing agent consisted of 5% ethanolamine oleate iopamidol (EOI) mixed with 10% ethanolamine oleate (Oldamin, ASKA Pharmaceutical, Osaka, Japan), and the same volume of nonionic contrast medium (iopamidol 300 mg I/mL, Iopamiron 300; Bayer Schering Pharma, Osaka, Japan) was injected via the balloon catheter until the varix and the feeder vein were visualized by EOI. We applied CARTO-II procedure to this treatment (Yamamoto et al 2020 ). After finishing injection of sclerosant, two microcoils (Tornado, Cook, Bloomington, IN, USA; Trufill, Cordis, Miami, FL, USA) were inserted into the drainage vein between the varix and the right renal vein through the microballoon catheter to prevent migration of sclerosant.…”