Advertisement

Single-Session Percutaneous Endovascular Mesocaval Shunt Creation and Balloon-Occluded Retrograde Transvenous Obliteration for the Treatment of Gastric Varices

Published:September 08, 2017DOI:https://doi.org/10.1016/j.avsg.2017.08.040
      In the setting of portal hypertension, the body responds by creating portosystemic venous shunts, which may lead to the development of varices. Endoscopic treatment of these varices is often warranted to prevent catastrophic bleeding. During the course of variceal treatment, 1 or more portosystemic shunts may be sacrificed, which may acutely exacerbate portal hypertension and reduce systemic venous return. This report describes percutaneous creation of a mesocaval shunt and balloon-occluded retrograde transvenous obliteration (BRTO) in a patient with cavernous transformation of the portal vein. The patient had previously undergone an unsuccessful attempt at transjugular intrahepatic portosystemic shunt (TIPS) creation with postoperative bleeding requiring splenectomy. As TIPS was not feasible, creation of a percutaneous mesocaval shunt provided an alternate pathway for portosystemic decompression, facilitating safe treatment of gastric varices with BRTO via a gastrorenal shunt. These procedures were performed simultaneously to reduce the risk of variceal bleeding from acute changes in portal venous pressures and redirect blood flow through the shunt to maintain patency. This is the first reported case of combined mesocaval shunt placement and BRTO in a single session.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Annals of Vascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Berzigotti A.
        • Seijo S.
        • Reverter E.
        • et al.
        Assessing portal hypertension in liver diseases.
        Expert Rev Gastroenterol Hepatol. 2013; 7: 141-155
        • Kumar V.
        • Abbas A.K.
        • Aster J.C.
        Robbins & Cotran Pathologic Basis of Disease.
        Elsevier Health Sciences, Amsterdam, Netherlands2014: 821-846
        • Rousselot L.M.
        • Moreno A.H.
        • Panke W.F.
        Studies on portal hypertension. IV. The clinical and physiopathologic significance of self-established (nonsurgical) portal systemic venous shunts.
        Ann Surg. 1959; 150: 384-412
        • D'Amico G.
        • Pasta L.
        • Vizzini G.B.
        • et al.
        Natural history of cirrhosis.
        J Hepatol. 1991; 13: S22
        • Garcia-Tsao G.
        • Sanyal A.J.
        • Grace N.D.
        • et al.
        • Practice Guidelines Committee of the American Association for the Study of Liver Diseases, the Practice Parameters Committee of the American College of Gastroenterology
        Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis.
        Hepatology. 2007; 46: 922-938
        • Graham D.Y.
        • Smith J.L.
        The course of patients after variceal hemorrhage.
        Gastroenterology. 1981; 80: 800-809
        • Carbonell N.
        • Pauwels A.
        • Serfaty L.
        • et al.
        Improved survival after variceal bleeding in patients with cirrhosis over the past two decades.
        Hepatology. 2004; 40: 652-659
        • Akahane T.
        • Iwasaki T.
        • Kobayashi N.
        • et al.
        Changes in liver function parameters after occlusion of gastrorenal shunts with balloon-occluded retrograde transvenous obliteration.
        Am J Gastroenterol. 1997; 92: 1026-1030
        • Saad W.E.
        • Wagner C.C.
        • Lippert A.
        • et al.
        Protective value of TIPS against the development of hydrothorax/ascites and upper gastrointestinal bleeding after balloon-occluded retrograde transvenous obliteration (BRTO).
        Am J Gastroenterol. 2013; 108: 1612-1619
        • Al-Osaimi A.
        • Sabri S.S.
        • Caldwell S.
        Balloon-occluded retrograde transvenous obliteration (BRTO): preprocedural evaluation and imaging.
        Semin Intervet Radiol. 2011; 28: 288-295
        • Moriarty J.M.
        • Kokabi N.
        • Kee S.T.
        Transvenous creation of a mesocaval shunt: report of use in the management of extrahepatic portal vein occlusion.
        J Vasc Interv Radiol. 2012; 23: 565-567
        • Nyman U.R.
        • Semba C.P.
        • Chang H.
        • et al.
        Percutaneous creation of a mesocaval shunt.
        J Vasc Interv Radiol. 1996; 7: 769-773