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Esophagogastric variceal hemorrhage: its treatment by percutaneous transephatic coronary vein occlusion
Insights
Percutaneous transhepatic coronary vein occlusion effectively treated esophagogastric variceal bleeding in 81% of actively bleeding patients. This angiographic technique also showed promise in preventing recurrent bleeding in high-risk individuals with portal hypertension.
Area of Science:
- Interventional Radiology
- Gastroenterology
- Vascular Surgery
Background:
- Esophagogastric variceal bleeding is a serious complication of portal hypertension.
- Existing treatments like vasopressin infusion and Blakemore tube tamponade have limitations.
- Patients at high risk for recurrent hemorrhage require effective preventative strategies.
Purpose of the Study:
- To evaluate the efficacy of percutaneous transhepatic coronary vein occlusion (PTCVO) in treating active esophagogastric variceal bleeding.
- To assess the effectiveness of PTCVO in preventing recurrent variceal hemorrhage in patients with portal hypertension.
Main Methods:
- The study involved 38 patients with esophagogastric varices.
- Patients were categorized into actively bleeding or high-risk non-bleeding groups.
- Coronary vein occlusion was achieved using various methods including metal clips, balloon catheters, autogenous clot with Gelfoam, and Gelfoam with sodium tetradecyl sulfate.
Main Results:
- Percutaneous transhepatic coronary vein occlusion successfully controlled active variceal bleeding in 81% of patients.
- The procedure demonstrated potential in providing protection against recurrent variceal hemorrhage in non-bleeding, high-risk patients.
Conclusions:
- Percutaneous transhepatic coronary vein occlusion is an effective angiographic technique for managing active esophagogastric variceal bleeding.
- PTCVO appears to be a valuable option for preventing recurrent variceal hemorrhage in patients with portal hypertension.
Abstract:
The angiographic technique percutaneous transhepatic coronary vein occlusion was used to treat esophagogastric variceal bleeding in 38 patients. There were two categories of patients: those actively bleeding who had not been controlled by continuous vasopressin infusion and/or Blakemore tube tamponade, and those with portal hypertension who were not actively bleeding at the time of transhepatic portal venography but who were at high risk for recurrent variceal hemorrhage. Coronary vein occlusion was achieved in 33 patients by (1) metal clip and cotton devices(one); (2) balloon catheter occlusion (two); (3) heat-treated autogenous clot and powdered absorbable gelatin sponge (Gelfoam) (13); and (4) Gelfoam strips soaked in sodium tetradecyl sulfate (17). Percutaneous coronary vein occlusion was effective in controlling 81% of the patients with actively bleeding varices. In patients who were not actively bleeding, percutaneous transhepatic coronary vein occlusion seemed to afford good protection for recurrent variceal hemorrhage.