Department of Radiology, Wakayama Medical University, Wakayama 641-8510, Japan.
World J Gastroenterol. 2012 Mar 28;18(12):1373-8. doi: 10.3748/wjg.v18.i12.1373.
To evaluate the usefulness of the microcatheter techniques in balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices.
Fifty-six patients with gastric varices underwent BRTOs using microcatheters. A balloon catheter was inserted into gastrorenal or gastrocaval shunts. A microcatheter was navigated close to the varices, and sclerosant was injected into the varices through the microcatheter during balloon occlusion. The next morning, thrombosis of the varices was evaluated by contrast enhanced computed tomography (CE-CT). In patients with incomplete thrombosis of the varices, a second BRTO was performed the following day. Patients were followed up with CE-CT and endoscopy.
In all 56 patients, sclerosant was selectively injected through the microcatheter close to the varices. In 9 patients, microcoil embolization of collateral veins was performed using a microcatheter. In 12 patients with incomplete thrombosis of the varices, additional injection of sclerosant was performed through the microcatheter that remained inserted overnight. Complete thrombosis of the varices was achieved in 51 of 56 patients, and the remaining 5 patients showed incomplete thrombosis of the varices. No recurrence of the varices was found in the successful 51 patients after a median follow up time of 10.5 mo. We experienced one case of liver necrosis, and the other complications were transient.
The microcatheter techniques are very effective methods for achieving a higher success rate of BRTO procedures.
评估微导管技术在球囊阻塞逆行经静脉闭塞（BRTO）胃静脉曲张中的应用价值。
56 例胃静脉曲张患者采用微导管进行 BRTO。将球囊导管插入胃肾或胃腔静脉分流道。将微导管引导至接近静脉曲张处，并在球囊闭塞时通过微导管向静脉曲张内注入硬化剂。次日早晨，通过对比增强计算机断层扫描（CE-CT）评估静脉曲张的血栓形成情况。对于静脉曲张血栓形成不完全的患者，次日再进行第二次 BRTO。通过 CE-CT 和内镜对患者进行随访。
在所有 56 例患者中，均通过微导管将硬化剂选择性注入靠近静脉曲张处。在 9 例患者中，使用微导管进行了微线圈栓塞侧支静脉。在 12 例静脉曲张血栓形成不完全的患者中，通过留置过夜的微导管再次进行硬化剂注射。56 例患者中有 51 例实现了静脉曲张的完全血栓形成，其余 5 例显示静脉曲张血栓形成不完全。在中位随访 10.5 个月后，51 例成功患者中未发现静脉曲张复发。我们经历了 1 例肝坏死病例，其他并发症均为一过性。
微导管技术是实现 BRTO 更高成功率的非常有效的方法。
