Department of Radiology, Faculty of Medicine, University of Yamanashi, Shimokato Chuo-city, Yamanashi, Japan.
J Vasc Interv Radiol. 2010 May;21(5):663-70. doi: 10.1016/j.jvir.2010.01.017.
To evaluate the feasibility for balloon-occluded retrograde transvenous obliteration (BRTO) for gastric varices without gastrorenal shunts.
Of 76 patients with gastric varices who were referred for treatment by BRTO, 11 did not have gastrorenal shunts. Contrast medium-enhanced computed tomography (CT) was performed in all patients; seven patients also underwent CT during splenic arteriography. BRTO was performed to insert a balloon catheter into the main draining vein and inject 5% ethanolamine oleate into gastric varices under the temporary balloon occlusion.
The main draining veins were the subphrenic transverse part of the inferior phrenic vein to the inferior vena cava in five patients, the pericardial vein to the left brachiocephalic vein in two, and the paraesophageal vein to the azygos vein in two. In two patients, the main draining vein was unknown. The overall success rate of BRTO in the nine cases with main draining veins was 67%; BRTO was successful in four of the patients in whom the inferior phrenic vein was the main draining vein, one of the patients in whom the pericardial vein was the main draining vein, and one of the patients in whom the paraesophageal vein was the main draining vein. In the other cases in which the inferior phrenic vein or pericardial vein was the main draining vein, BRTO could not be performed because of extravasation. In another patient in whom the paraesophageal vein was the main draining vein, the main draining pathway could not be identified at angiography because of a complicated azygos venous network.
It is feasible to use BRTO to treat cases of gastric varices in which the inferior phrenic vein is the main draining vein. Cases in which the main draining pathway is the pericardial vein are less feasibile for BRTO. The use of BRTO in cases in which the paraesophageal vein is the main draining vein is possible but may be difficult because of a complicated venous network.
评估无胃肾分流情况下使用球囊阻塞逆行经静脉闭塞（BRTO）治疗胃静脉曲张的可行性。
在 76 例因 BRTO 治疗而转诊的胃静脉曲张患者中，有 11 例无胃肾分流。所有患者均行对比增强 CT（CT）检查；7 例患者还在行脾动脉造影时进行 CT 检查。BRTO 是将球囊导管插入主引流静脉，并在临时球囊闭塞下将 5%乙醇胺油酸注入胃静脉曲张内。
5 例患者的主引流静脉为下腔静脉下腔静脉膈肌下横段至下腔静脉，2 例患者为心包静脉至左头臂静脉，2 例患者为食管旁静脉至奇静脉。2 例患者主引流静脉未知。在 9 例有主引流静脉的患者中，BRTO 的总体成功率为 67%；在主引流静脉为下腔静脉的 4 例患者中，心包静脉为 1 例，食管旁静脉为 1 例，BRTO 成功。在其他下腔静脉或心包静脉为主要引流静脉的病例中，由于外渗，BRTO 无法进行。在另 1 例食管旁静脉为主要引流静脉的患者中，由于奇静脉网络复杂，血管造影无法确定主要引流途径。
使用 BRTO 治疗下腔静脉为主要引流静脉的胃静脉曲张是可行的。心包静脉为主引流途径的病例行 BRTO 的可行性较低。食管旁静脉为主引流静脉的病例行 BRTO 是可行的，但由于静脉网络复杂，可能会有难度。
