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使用钆特醇作为替代造影剂对碘过敏患者进行球囊闭塞逆行静脉闭塞术

Balloon-occlusion Retrograde Transvenous Obliteration Using Gadoteridol As an Alternative Contrast Agent in a Patient with Iodine Allergy.

作者信息

Iwasa Taisei, Adachi Seiji, Oyama Yusuke, Suzuki Yusuke, Mabuchi Masatoshi, Nakamura Hironori, Shimazaki Makoto, Nishiwaki Shinji, Iwashita Takuji, Shimizu Masahito

机构信息

Department of Gastroenterology, Ibi Kosei Hospital, Gifu-Seino Medical Center, Japan.

Department of Gastroenterology, Gihoku Kosei Hospital, Gifu-Seino Medical Center, Japan.

出版信息

Intern Med. 2024 Apr 15;63(8):1099-1103. doi: 10.2169/internalmedicine.2481-23. Epub 2023 Sep 8.

DOI:10.2169/internalmedicine.2481-23
PMID:37690844
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11081900/
Abstract

A 70-year-old woman with liver cirrhosis presented with gastric varices and recurrent hepatic encephalopathy. Magnetic resonance imaging (MRI) showed a splenorenal shunt, and balloon-occluded retrograde transvenous obliteration (B-RTO) was indicated but could not be performed due to iodine allergy. We then performed B-RTO using gadoteridol, an MRI contrast medium, instead of iodine contrast and successfully occluded the shunt vessel. After the procedure, hepatic encephalopathy did not recur, and the size of the gastric varices was reduced. This experience may aid in the management of iodine-allergic patients requiring interventional radiological treatment.

摘要

一名70岁肝硬化女性患者出现胃静脉曲张和复发性肝性脑病。磁共振成像（MRI）显示脾肾分流，虽建议行球囊闭塞逆行静脉栓塞术（B-RTO），但因碘过敏无法进行。随后，我们使用钆特醇（一种MRI造影剂）代替碘造影剂进行B-RTO，成功闭塞了分流血管。术后，肝性脑病未再复发，胃静脉曲张大小减小。这一经验可能有助于管理需要介入放射治疗的碘过敏患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4cf/11081900/e34b2f06488c/1349-7235-63-1099-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4cf/11081900/efa79bd7bfbf/1349-7235-63-1099-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4cf/11081900/cb3bf2b32991/1349-7235-63-1099-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4cf/11081900/3b274e9d3761/1349-7235-63-1099-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4cf/11081900/e34b2f06488c/1349-7235-63-1099-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4cf/11081900/efa79bd7bfbf/1349-7235-63-1099-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4cf/11081900/cb3bf2b32991/1349-7235-63-1099-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4cf/11081900/3b274e9d3761/1349-7235-63-1099-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4cf/11081900/e34b2f06488c/1349-7235-63-1099-g004.jpg

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本文引用的文献

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Evidence-based clinical practice guidelines for liver cirrhosis 2020.《2020年肝硬化循证临床实践指南》
Hepatol Res. 2021 Jul;51(7):725-749. doi: 10.1111/hepr.13678. Epub 2021 Jul 6.
2
Recent development of balloon-occluded retrograde transvenous obliteration.球囊阻断逆行经静脉闭塞术的最新进展。
J Gastroenterol Hepatol. 2019 Mar;34(3):495-500. doi: 10.1111/jgh.14463. Epub 2018 Sep 17.
3
Is there a role for combined sclerotherapy and ligation in the endoscopic treatment of gastroesophageal varices?硬化疗法和结扎术联合应用在内镜下治疗胃食管静脉曲张中是否有作用？
Gastrointest Endosc. 2017 Aug;86(2):316-318. doi: 10.1016/j.gie.2017.02.005.
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Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases.肝硬化门静脉高压出血：风险分层、诊断及管理：美国肝病研究协会2016年实践指南
Hepatology. 2017 Jan;65(1):310-335. doi: 10.1002/hep.28906. Epub 2016 Dec 1.
5
Contemporary concepts of the medical therapy of portal hypertension under liver cirrhosis.肝硬化门静脉高压症医学治疗的当代概念
World J Gastroenterol. 2015 May 28;21(20):6117-26. doi: 10.3748/wjg.v21.i20.6117.
6
Breakthrough reactions of iodinated and gadolinium contrast media after oral steroid premedication protocol.口服类固醇预处理方案后碘造影剂和钆造影剂的突破性反应。
BMC Med Imaging. 2014 Oct 6;14:34. doi: 10.1186/1471-2342-14-34.
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Carbon dioxide (CO2) vs iodinated contrast digital subtraction angiography during balloon-occluded retrograde transvenous obliteration (BRTO) using foam sclerosant for gastric varices.二氧化碳（CO2）与碘对比剂数字减影血管造影在使用泡沫硬化剂行球囊阻断逆行静脉内栓塞术（BRTO）治疗胃静脉曲张中的应用。
J Vasc Interv Radiol. 2012 Nov;23(11):1453-1459.e1. doi: 10.1016/j.jvir.2012.08.004.
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