Ruptured high flow gastric varices with an intratumoral arterioportal shunt treated with balloon-occluded retrograde transvenous obliteration during temporary balloon occlusion of a hepatic artery

A patient presented with hematemesis due to gastric variceal bleeding with an intratumoral arterioportal shunt. Contrast-enhanced CT revealed gastric varices and hepatocellular carcinoma with tumor thrombi in the right portal vein. Angiography and angio-CT revealed a marked intratumoral arterioporta...

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Bibliographic Details
Published in:World journal of gastroenterology : WJG 2006-09, Vol.12 (33), p.5404-5407
Main Authors: Nakai, Motoki, Sato, Morio, Tanihata, Hirohiko, Sonomura, Tetsuo, Sahara, Shinya, Kawai, Nobuyuki, Kimura, Masashi, Terada, Masaki
Format: Article
Language:English
Subjects:
Aged
Angiography
Balloon Occlusion - methods
Case Report
Catheterization - adverse effects
Catheterization - instrumentation
Esophageal and Gastric Varices - diagnosis
Hepatic Artery - pathology
Humans
Liver - pathology
Male
Tomography, X-Ray Computed - methods
肝细胞癌
胃血管
静脉血管
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Summary:A patient presented with hematemesis due to gastric variceal bleeding with an intratumoral arterioportal shunt. Contrast-enhanced CT revealed gastric varices and hepatocellular carcinoma with tumor thrombi in the right portal vein. Angiography and angio-CT revealed a marked intratumoral arterioportal shunt accompanied with reflux into the main portal vein and gastric varices. Balloon-occluded retrograde venography from the gastro-renal shunt showed no visualization of gastric varices due to rapid blood flow through the intratumoral arterioportal shunt. The hepatic artery was temporarily occluded with a balloon catheter to reduce the blood flow through the arterioportal shunt, and then concurrent balloon-occluded retrograde transvenous obliteration （BRTO） was achieved. Vital signs stabilized immediately thereafter, and contrast-enhanced CT revealed thrombosed gastric varices. Worsening of hepatic function was not recognized. BRTO combined with temporary occlusion of the hepatic artery is a feasible interventional procedure for ruptured high flow gastric varices with an intratumoral arterioportal shunt.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v12.i33.5404