From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (H.C.K., J.W. Chung., H.J.J., J.W. Choi); Department of Diagnostic Radiology, Fukui-ken Saiseikai Hospital, Fukui, Japan (S.M.); Department of Radiology, Division of Interventional Radiology and Department of Surgery, Division of Liver and Pancreas Transplantation, University of California at Los Angeles Medical Center, David Geffen School of Medicine, Los Angeles, Calif (E.W.L.); and Department of Diagnostic Radiology, Changi General Hospital, Singapore (D.Y.L.).
Radiographics. 2024 Aug;44(8):e230140. doi: 10.1148/rg.230140.
Ectopic varices are rare but potentially life-threatening conditions usually resulting from a combination of global portal hypertension and local occlusive components. As imaging, innovative devices, and interventional radiologic techniques evolve and are more widely adopted, interventional radiology is becoming essential in the management of ectopic varices. The interventional radiologist starts by diagnosing the underlying causes of portal hypertension and evaluating the afferent and efferent veins of ectopic varices with CT. If decompensated portal hypertension is causing ectopic varices, placement of a transjugular intrahepatic portosystemic shunt is considered the first-line treatment, although this treatment alone may not be effective in managing ectopic variceal bleeding because it may not sufficiently resolve focal mesenteric venous obstruction causing ectopic varices. Therefore, additional variceal embolization should be considered after placement of a transjugular intrahepatic portosystemic shunt. Retrograde transvenous obliteration can serve as a definitive treatment when the efferent vein connected to the systemic vein is accessible. Antegrade transvenous obliteration is a vital component of interventional radiologic management of ectopic varices because ectopic varices often exhibit complex anatomy and commonly lack catheterizable portosystemic shunts. Superficial veins of the portal venous system such as recanalized umbilical veins may provide safe access for antegrade transvenous obliteration. Given the absence of consensus and guidelines, a multidisciplinary team approach is essential for the individualized management of ectopic varices. Interventional radiologists must be knowledgeable about the anatomy and hemodynamic characteristics of ectopic varices based on CT images and be prepared to consider appropriate options for each specific situation. RSNA, 2024 Supplemental material is available for this article.
异位静脉曲张是一种罕见但可能危及生命的病症，通常是由门静脉高压的全身性和局部阻塞性因素共同作用引起的。随着影像学、创新设备和介入放射技术的不断发展和广泛应用，介入放射学在异位静脉曲张的治疗中变得至关重要。介入放射医师首先通过 CT 诊断门静脉高压的潜在病因，并评估异位静脉曲张的入、出静脉。如果代偿失调的门静脉高压导致异位静脉曲张，那么经颈静脉肝内门体分流术（TIPS）的放置被认为是一线治疗方法，尽管这种单一治疗方法可能无法有效治疗异位静脉曲张出血，因为它可能无法充分解决导致异位静脉曲张的局部肠系膜静脉阻塞。因此，在放置 TIPS 后应考虑额外的静脉曲张栓塞治疗。如果连接至体循环的出静脉可到达，逆行经静脉闭塞术可作为一种确定性治疗方法。顺行经静脉闭塞术是异位静脉曲张介入放射管理的重要组成部分，因为异位静脉曲张通常表现出复杂的解剖结构，并且通常缺乏可置管的门体分流术。门静脉系统的浅表静脉，如再通的脐静脉，可能为顺行经静脉闭塞术提供安全的入路。鉴于缺乏共识和指南，对于异位静脉曲张的个体化管理，多学科团队方法至关重要。介入放射医师必须根据 CT 图像了解异位静脉曲张的解剖和血流动力学特征，并准备好考虑针对每种具体情况的适当选择。RSNA，2024 补充材料可用于本文。
