Lee Dong Kyu, Kwak Jung Won, Cho Sung Bum
Korea University Anam Hospital, Seoul, Republic of Korea.
Abdom Radiol (NY). 2024 Dec 21. doi: 10.1007/s00261-024-04777-9.
To assess the treatment outcomes of vascular plug-assisted retrograde transvenous obliteration (PARTO) for gastric varices based on hemodynamic changes observed in pre- and post-procedural CT scans.
This single-center study included 43 patients with gastric varices who underwent PARTO between June 2017 and December 2023. Peri-procedural CT and endoscopic findings were retrospectively reviewed to analyze the afferent and draining veins of gastric varices, identify any residual varices or afferent veins after treatment, assess the technical and clinical successes, and determine statistically significant variables associated with clinical success.
In the pre-procedural CT, the most common dominant afferent vein was the posterior gastric vein (81.4%), followed by the short gastric vein (46.5%) and the left gastric vein (37.2%). Post-procedural CT scans were available for 34 patients (34/43), revealing residual varices and afferent veins in 10 patients (10/34). Seven patients had unknown clinical outcomes due to insufficient follow-up data. The technical and clinical success rates were 93.0% (40/43) and 77.8% (28/36), respectively. In the multivariable logistic regression model, the dominant left gastric vein observed in the pre-procedural CT was a significant negative predictor of clinical success (odds ratio, 0.007; P = 0.027). The sum of the diameters of all afferent veins was also a significant negative predictor (odds ratio, 0.708; P = 0.044).
A dominant left gastric vein and a larger sum of the diameters of all afferent veins observed in the pre-procedural CT may be associated with an increased risk of clinical failure of PARTO. Therefore, pretherapeutic CT evaluation of the hemodynamics of gastric varices, particularly the type, dominance, and diameter of the afferent veins, could be beneficial for achieving successful PARTO.
基于术前和术后CT扫描观察到的血流动力学变化，评估血管栓塞辅助逆行经静脉闭塞术（PARTO）治疗胃静脉曲张的疗效。
这项单中心研究纳入了2017年6月至2023年12月期间接受PARTO治疗的43例胃静脉曲张患者。回顾性分析围手术期CT和内镜检查结果，以分析胃静脉曲张的输入和引流静脉，识别治疗后任何残留的静脉曲张或输入静脉，评估技术和临床成功率，并确定与临床成功相关的统计学显著变量。
在术前CT中，最常见的主要输入静脉是胃后静脉（81.4%），其次是胃短静脉（46.5%）和胃左静脉（37.2%）。34例患者（34/43）有术后CT扫描结果，其中10例患者（10/34）显示有残留静脉曲张和输入静脉。7例患者因随访数据不足，临床结局未知。技术成功率和临床成功率分别为93.0%（40/43）和77.8%（28/36）。在多变量逻辑回归模型中，术前CT观察到的主要胃左静脉是临床成功的显著负性预测因素（比值比，0.007；P = 0.027）。所有输入静脉直径之和也是一个显著的负性预测因素（比值比，0.708；P = 0.044）。
术前CT中观察到主要的胃左静脉和所有输入静脉直径之和较大，可能与PARTO临床失败风险增加有关。因此，术前对胃静脉曲张的血流动力学进行CT评估，特别是输入静脉的类型、优势和直径，可能有助于实现PARTO的成功。
