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J Vasc Interv Radiol. 2012 Oct;23(10):1339-46. doi: 10.1016/j.jvir.2012.06.030.

Anatomic features and retrograde transvenous obliteration of duodenal varices associated with mesocaval collateral pathway.

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  • 1Department of Radiology, Faculty of Medicine, Oita University, Yufu-shi, Oita, Japan. okahara@oita-u.ac.jp

Abstract

PURPOSE:

To evaluate techniques and efficacy of retrograde transvenous obliteration for the treatment of duodenal varices associated with mesocaval collateral pathway.

MATERIALS AND METHODS:

Six consecutive cases of large/growing or ruptured duodenal varices treated by retrograde transvenous obliteration were retrospectively reviewed. Selective balloon-occluded retrograde transvenous obliteration (B-RTO) with 5% ethanolamine oleate (EO) was performed in all cases. When EO could not be sufficiently stagnated in the varices, additional/alternative techniques were performed, including coil embolization of afferent vein or intravariceal injection of n-butyl-2-cyanoacrylate (NBCA). Clinical findings, anatomic features of duodenal varices, obliteration techniques, complications, posttherapeutic computed tomography (CT) findings, and follow-up endoscopic findings were investigated.

RESULTS:

All duodenal varices were located at the second/third junction of the duodenum and were fed by single (n = 1) or multiple (n = 5) pancreaticoduodenal veins. One varix fed by a single afferent vein was successfully treated by simple selective B-RTO technique alone. The other five cases required coil embolization of afferent vein (n = 1) or intravariceal injection of NBCA (n = 4) because sclerosant was not sufficiently stagnated in the varices. CT 1 week after the procedure showed complete occlusion of the varices in all cases. A duodenal ulcer at the variceal site developed in one patient and was successfully treated by medication. Follow-up endoscopy showed disappearance of varices in all cases, and no recurrence was observed during follow-up.

CONCLUSIONS:

Retrograde transvenous obliteration is an effective technique for the treatment of duodenal varices. However, additional/alternative techniques are required for successful treatment because of the complex anatomic features of duodenal varices.

PMID:
22999754
DOI:
10.1016/j.jvir.2012.06.030
[PubMed - indexed for MEDLINE]
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