[Percutaneous transhepatic varices embolization with cyanoacrylate in the treatment of varices].

OBJECTIVE

To test the safety and validity of percutaneous transhepatic variceal embolization (PTVE) with tissue adhesive cyanoacrylate.

METHODS

PTVE with cyanoacrylate was performed on 92 patients with gastroesophageal varices, 53 males and 39 females, aged 62.5 (7-84): cyanoacrylate was injected into the varices and the afferent veins. Endoscopy and CT were performed to evaluate the embolization.

RESULTS

PTVE was successfully completed in 89 of the 92 patients with a technical success rate of 96.7%, and 3 patients died within 1 month. Among the other 86 patients 3 types of cyanoacrylate embolization were achieved: embolization of coronary vein, vessels around gastric fundus, and variceal lower esophagus veins in 40 patients, embolization of coronary vein, gastric fundus and pericardial varices in 33 patients, and embolization of sole gastric coronary vein stem in 13 patients. Acute variceal bleeding in 18 patients was immediately arrested after the procedure, with an acute bleeding control rate of 100%. Eighty-six patients were followed up for 31.5 (6-52) months. The general variceal recurrence rate was 14.1% (10/71), and the variceal recurrence rate of the coronary vein embolization group was 100% (2/2), significantly higher than those of the groups of esophagus and fundus embolization and gastric fundus and cardia varices embolization [7.5% (3/40) and 17.2% (5/29) respectively, P = 0.006]. The general rebleeding rate was 16.3% (14/86), and the rebleeding rates of the group of coronary vein embolization was 69.2% (9/13), significantly higher than those of the groups of esophagus and fundus embolization and gastric fundus and cardia varices embolization [7.5% (3/40) and 15. 2% (5/33) respectively, P = 0.0092]. No obvious ectopic embolization was found. The mortality was 24.7% (22/89). The cause of rebleeding in coronary vein embolization was mainly recurrent variceal bleeding, whereas that in the group of fundus and esophagus variceal embolization was mainly hypertensive gastropathy.

CONCLUSION

PTVE with cyanoacrylate is safe and effective for the obliteration of gastroesophageal varices in cirrhotic patients.