Emergency Plug-Assisted Retrograde Transvenous Obliteration for Active Bleeding from Ruptured Gastric Varices

To evaluate the safety and effectiveness of emergency plug-assisted retrograde transvenous obliteration (PARTO) for active bleeding from ruptured gastric varices (GVs).

Twenty-one patients with active bleeding from ruptured GVs were included in this retrospective study. Ten patients (47.6%) showed life-threatening hemorrhage (systolic blood pressure, <90 mm Hg) just before emergency PARTO. All patients underwent emergency PARTO after initial ineffective endoscopic cyanoacrylate injection (n = 9) or because endoscopic injection was not possible (n = 12).

Emergency PARTO was technically successful in all 21 patients. Mean fluoroscopic time was 30.8 minutes (range, 10-62 minutes). There were no procedure-related adverse events. Hemostasis was obtained in 20 (95.2%) of 21 patients immediately after PARTO. In 16 patients who underwent computed tomography (CT), complete thrombosis or obliteration of GVs and portosystemic shunt was observed. With the exception of 1 patient who underwent external transfer, 15 patients died within a mean of 196 days (range, 1-1,111 days), whereas 5 remained alive for a mean of 38.9 months (range, 17.1-74.2 months). Seven died within 30 days due to ischemia-related multiorgan failure (n = 5), hypovolemic shock (n = 1), or rapid progression of hepatocellular carcinoma (HCC) (n = 1). The causes of death in the remaining 9 patients were bleeding from esophageal varices (n = 2), liver failure (n = 2), and rapid progression of HCC (n = 5). The median patient survival time was 47 days (95% confidence interval, 0‒124 days). There was no case of rebleeding or recurrence of GVs.

Emergency PARTO appears to be a fast, safe, and effective treatment option to stop active bleeding from ruptured GVs; however, survival in this population is modest because of comorbidities and complications of shock.