Li Gabriel E, Chick Jeffrey Forris Beecham, Monroe Eric J, Abad-Santos Matthew, Hua Ethan W, Shin David S
Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA.
The Deep Vein Institute, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA.
CVIR Endovasc. 2024 Sep 4;7(1):65. doi: 10.1186/s42155-024-00479-x.
To report antegrade transvenous obliteration, with or without concurrent portosystemic shunt creation, for the treatment of hemorrhagic rectal varices.
Eight patients, including five (62.5%) females and three (37.5%) males, with mean age of 55.8 ± 13.8 years (range: 30-70 years), underwent transjugular-approach antegrade transvenous obliteration of rectal varices, with or without portosystemic shunt creation. Demographic data, procedural details, technical success of variceal obliteration, clinical success, adverse events, and follow-up outcomes were retrospectively recorded. Clinical success was defined as resolution of rectal hemorrhage.
Portal venous access was achieved via a transjugular intrahepatic approach in all patients. The inferior mesenteric vein was selected, and foamy sclerosant (1:2:3 mixture by volume of ethiodized oil: sodium tetradecyl sulfate: air) was injected into the rectal varices with antegrade balloon occlusion in seven (87.5%) and without balloon occlusion in one (12.5%). Five of eight (62.5%) patients underwent concomitant transjugular intrahepatic portosystemic shunt (TIPS) creation (mean diameter 8.4 ± 0.9-mm) immediately following transvenous obliteration. Technical success of variceal obliteration was achieved in all patients. There were no immediate post-procedural adverse events. There were no reported occurrences of rectal ischemia, perforation, or stricture following obliteration. Two (40%) of the patients who underwent concomitant TIPS creation developed hepatic encephalopathy within 30 days of the procedure, which was medically managed. Clinical resolution of hemorrhage was achieved in all patients with no recurrent rectal variceal hemorrhage during mean follow-up of 666 ± 396 days (range: 14 - 1,224 days).
Transvenous obliteration, with or without concurrent TIPS creation, is feasible with promising results for the management of rectal variceal hemorrhage.
报告经静脉顺行闭塞术，无论是否同时建立门体分流，用于治疗出血性直肠静脉曲张。
8例患者，包括5例（62.5%）女性和3例（37.5%）男性，平均年龄55.8±13.8岁（范围：30 - 70岁），接受经颈静脉途径顺行闭塞直肠静脉曲张，无论是否建立门体分流。回顾性记录人口统计学数据、手术细节、静脉曲张闭塞的技术成功率、临床成功率、不良事件及随访结果。临床成功定义为直肠出血停止。
所有患者均通过经颈静脉肝内途径实现门静脉通路。选择肠系膜下静脉，7例（87.5%）患者在顺行球囊闭塞下将泡沫硬化剂（按体积比为乙碘油：十四烷基硫酸钠：空气1:2:3的混合物）注入直肠静脉曲张，1例（12.5%）未行球囊闭塞。8例患者中有5例（62.5%）在静脉闭塞后立即同时行颈静脉肝内门体分流术（TIPS）（平均直径8.4±0.9毫米）。所有患者均实现了静脉曲张闭塞的技术成功。术后无即刻不良事件。闭塞后未报告发生直肠缺血、穿孔或狭窄。5例同时行TIPS的患者中有2例（40%）在术后30天内发生肝性脑病，经药物治疗。所有患者均实现了出血的临床缓解，在平均666±396天（范围：14 - 1224天）的随访期间无复发性直肠静脉曲张出血。
经静脉闭塞术，无论是否同时行TIPS，对于直肠静脉曲张出血的治疗是可行的，且效果良好。
