Management of Gastric Varices Unsuccessfully Treated by Balloon-Occluded Retrograde Transvenous Obliteration: Long-Term Follow-Up and Outcomes
Figure 2
A 36-year-old woman with gastroesophageal varices. The patient visited our outpatient clinic because of general fatigue. Hematologic tests showed liver dysfunction and pancytopenia, and the gastroesophageal varices tended to worsen despite several sessions of endoscopic therapy. An enhanced computed tomography (CT) scan coronal image (a) showed dilated and tortuous veins at the gastric fundus (arrow), and large gastric varices supplied by the left gastric vein (arrowhead). Endoscopic examination of the stomach (b) showed significant large tumorous gastroesophageal varices (F3). Such varices pose a high risk of variceal bleeding and are an indication for embolotherapy. This patient underwent combined balloon-occluded retrograde transvenous obliteration (BRTO) and PTO therapy. Direct portography (c) showed gastroesophageal varices from the left gastric vein and posterior gastric vein. Balloon-occluded left gastric venography and left adrenal venography after embolization of the posterior gastric vein with platinum coils showed the left inferior phrenic vein and intercostal vein as collateral vessels (d). Fluoroscopic image obtained at 4 hours after embolotherapy shows the varices filled with iopamidol (e). An enhanced coronal CT scan obtained 14 days after embolotherapy showing the gastric varices and the left gastric vein as a low-density area ((f), arrow and arrowhead), suggesting complete obliteration. Endoscopic examination conducted 6 months after the embolotherapy showed eradication of the gastroesophageal varices (g).
