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Percutaneous transhepatic obliteration of gastro-oesophageal varices
Insights
This study explored transhepatic portal-vein catheterization to stop gastro-esophageal variceal bleeding in cirrhotic patients. The procedure effectively stopped bleeding in most patients, but long-term success requires further investigation.
Area of Science:
- Interventional Radiology
- Hepatology
- Gastroenterology
Background:
- Gastro-esophageal variceal bleeding is a serious complication of decompensated cirrhosis.
- Conservative therapies often fail to control acute variceal hemorrhage.
- Transhepatic portal-vein catheterization offers a potential interventional approach.
Abstract:
Percutaneous transhepatic portal-vein catheterisation was attempted to obliterate the major variceal venous supply in 13 decompensated cirrhotic patients, who continued to bleed after conservative therapy. Obliteration was achieved and bleeding stopped in 7 patients. In 5 patients obliteration was technically unsuccessful. The remaining patient had an unsuspected portal-vein block diagnosed by the transhepatic technique. 1 patient with successfully obliterated varices died after a haemothorax and haemorperitoneum developed. Follow-up splenic venography at three to six months in the 6 successfully thrombosed patients showed that 4 had persistent obliteration and had not re-bled. 2 patients re-bled from incompletely obliterated varices. It is concluded that selective obliteration of the major variceal supply is effective in stopping acute gastro-oesophageal variceal bleeding, but that greater experience is necessary before the long-term effectiveness of the procedure can be determined.