Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices: Use of CT-Guided Foam Sclerotherapy to Optimize Technique
Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices: Use of CT-Guided Foam Sclerotherapy to Optimize Technique
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DOI：
10.2214/ajr.11.7002
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发表时间：
2012-07-01
影响因子：
5
通讯作者：
d'Othee, Bertrand Janne
中科院分区：
文献类型：
--
作者：
Koizumi, Jun;Hashimoto, Takeshi;d'Othee, Bertrand Janne
目标。球囊闭塞逆行经静脉封堵术传统上是基于液体硬化疗法。然而，过量和全身溢出的液体硬化剂可导致严重的并发症，如溶血，导致血红蛋白尿、过敏、急性呼吸窘迫综合征等疾病。本研究的目的是评价C臂CT引导下泡沫硬化治疗的效果，以减少硬化剂的用量，优化球囊闭塞逆行经静脉封堵术的安全性，同时保持其有效性。连续登记的20例胃底静脉曲张患者接受了球囊闭塞的经静脉注射聚多酚泡沫封堵术。用C型臂CT引导确定靶血管充气情况。在这项前瞻性编码数据库的回顾分析中，比较了经静脉闭塞前使用的聚烷醇净剂量和用于静脉造影的造影剂的总剂量，并记录了随后的并发症，包括血红蛋白尿。结果：在所有患者的C臂CT上，靶血管均可见泡沫。球囊闭塞逆行介入治疗的平均剂量(3.9mL/-1.5mL)显著低于静脉造影剂的平均剂量(16.4mL/-7.9mL)(p<；0.001)。只有一名患者出现了血红蛋白尿。除1例再通外，经静脉闭塞1周后CT增强扫描证实完全静脉曲张血栓形成(成功率95%)。在一名患者中，空气在经静脉闭塞过程中迁移到肝脏，但被自发吸收。无严重并发症发生。结论：C臂CT引导下球囊封堵经静脉逆行封堵术，硬化剂用量明显减少，并发症发生率低，技术成功率和疗效均较高。
OBJECTIVE. Balloon-occluded retrograde transvenous obliteration has been traditionally based on liquid sclerotherapy. However, overdose and systemic spillage of liquid sclerosant can cause severe complications, such as hemolysis, which lead to hemoglobinuria, allergy, acute respiratory distress syndrome, and other disorders. The purpose of this study was to evaluate the performance of foam sclerotherapy with C-arm CT guidance to reduce the amount of sclerosant and to optimize the safety of balloon-occluded retrograde transvenous obliteration while preserving its efficacy.MATERIALS AND METHODS. Twenty consecutively registered patients with gastric varices underwent balloon-occluded retrograde transvenous obliteration with polidocanol foam. C-arm CT guidance was used to confirm gas filling of the target vessels. In this retrospective analysis of a prospectively encoded database, total net doses of polidocanol used for transvenous obliteration and of contrast medium used for venography before transvenous obliteration were compared, and subsequent complications, including hemoglobinuria, were documented.RESULTS. In all patients, foam was observed in the target vessels at C-arm CT. The mean dose of polidocanol used for balloon-occluded retrograde transvenous obliteration (3.9 +/- 1.5 mL) was significantly smaller (p < 0.001) than the dose of contrast medium used for venography (16.4 +/- 7.9 mL). Hemoglobinuria was found in only one patient. Except in one instance of recanalization, full variceal thrombosis was confirmed at contrast-enhanced CT 1 week after transvenous obliteration (success rate, 95%). In one patient, air migrated into the liver during transvenous obliteration but was spontaneously absorbed. No serious complication occurred.CONCLUSION. Balloon-occluded retrograde transvenous obliteration with polidocanol foam under C-arm CT guidance allowed significant reduction of sclerosant dose and resulted in a low complication rate while a high technical success rate and efficacy were maintained.