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Title: Septic Complication After Balloon-Occluded Retrograde Transvenous Obliteration of Duodenal Variceal Bleeding

Abstract

We report a 64-year-old woman with duodenal varices who underwent balloon-occluded retrograde transvenous obliteration (B-RTO) complicated by intraprocedural variceal rupture. The patient developed shivering and a fever higher than 40{sup o}C 3 days after the B-RTO procedure. A blood culture grew Entereobacter cloacoe. This case represents a rare septic complication of B-RTO for duodenal varices.

Authors:
; ;  [1];  [2]; ; ;  [1]
  1. Kyoto University Graduate School of Medicine, Department of Radiology (Japan)
  2. Kyoto University Graduate School of Medicine, Department of Surgery (Japan)
Publication Date:
OSTI Identifier:
21428901
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 33; Journal Issue: 6; Other Information: DOI: 10.1007/s00270-009-9740-2; Copyright (c) 2010 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; RUPTURES; SMALL INTESTINE; VEINS; BLOOD VESSELS; BODY; CARDIOVASCULAR SYSTEM; DIGESTIVE SYSTEM; FAILURES; GASTROINTESTINAL TRACT; INTESTINES; ORGANS

Citation Formats

Akasaka, Thai, Shibata, Toshiya, E-mail: ksj@kuhp.kyoto-u.ac.jp, Isoda, Hiroyoshi, Taura, Kojiro, Arizono, Shigeki, Shimada, Kotaro, and Togashi, Kaori. Septic Complication After Balloon-Occluded Retrograde Transvenous Obliteration of Duodenal Variceal Bleeding. United States: N. p., 2010. Web. doi:10.1007/S00270-009-9740-2.
Akasaka, Thai, Shibata, Toshiya, E-mail: ksj@kuhp.kyoto-u.ac.jp, Isoda, Hiroyoshi, Taura, Kojiro, Arizono, Shigeki, Shimada, Kotaro, & Togashi, Kaori. Septic Complication After Balloon-Occluded Retrograde Transvenous Obliteration of Duodenal Variceal Bleeding. United States. doi:10.1007/S00270-009-9740-2.
Akasaka, Thai, Shibata, Toshiya, E-mail: ksj@kuhp.kyoto-u.ac.jp, Isoda, Hiroyoshi, Taura, Kojiro, Arizono, Shigeki, Shimada, Kotaro, and Togashi, Kaori. 2010. "Septic Complication After Balloon-Occluded Retrograde Transvenous Obliteration of Duodenal Variceal Bleeding". United States. doi:10.1007/S00270-009-9740-2.
@article{osti_21428901,
title = {Septic Complication After Balloon-Occluded Retrograde Transvenous Obliteration of Duodenal Variceal Bleeding},
author = {Akasaka, Thai and Shibata, Toshiya, E-mail: ksj@kuhp.kyoto-u.ac.jp and Isoda, Hiroyoshi and Taura, Kojiro and Arizono, Shigeki and Shimada, Kotaro and Togashi, Kaori},
abstractNote = {We report a 64-year-old woman with duodenal varices who underwent balloon-occluded retrograde transvenous obliteration (B-RTO) complicated by intraprocedural variceal rupture. The patient developed shivering and a fever higher than 40{sup o}C 3 days after the B-RTO procedure. A blood culture grew Entereobacter cloacoe. This case represents a rare septic complication of B-RTO for duodenal varices.},
doi = {10.1007/S00270-009-9740-2},
journal = {Cardiovascular and Interventional Radiology},
number = 6,
volume = 33,
place = {United States},
year = 2010,
month =
}
  • A 60-year-old woman with massive hemorrhage from duodenal varices was transferred to our hospital for the purpose of transcatheter intervention. Although digital subtraction arterial portography could not depict the entire pathway of collateral circulation, the efferent route of the duodenal varices was clearly demonstrated on subsequent CT during arterial portography. Balloon-occluded retrograde transvenous obliteration (B-RTO) of the varices was performed via the efferent vein and achieved complete thrombosis of the varices.
  • No abstract prepared.
  • PurposeTo compare the clinical outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) using ethanolamine oleate (EO), BRTO using sodium tetradecyl sulfate (STS) foam, and vascular plug-assisted retrograde transvenous obliteration (PARTO).Materials and MethodsFrom April 2004 to February 2015, ninety-five patients underwent retrograde transvenous obliteration for gastric varices were analyzed retrospectively. BRTO with EO was performed in 49 patients, BRTO with STS foam in 25, and PARTO in 21. Among them, we obtained follow-up data in 70 patients. Recurrence of gastric varices was evaluated by follow-up endoscopy or CT. Medical records were reviewed for the clinical efficacy. Statistical analyses were performed by Kaplan–Meiermore » method, Chi-square, Fisher’s, and Kruskal–Wallis tests.ResultsTechnical and clinical success was 94.7 %. As major complications, a hemoglobinuria and a death due to disseminated intravascular coagulation (DIC) were occurred in two patients with BRTO using EO. Recurrence occurred more frequently in PARTO group (P < 0.05). Recurrence occurred in three patients in BRTO using EO group and four patients in PARTO group with 3.2 and 32.8 % of each expected 1-year recurrence rates. There was no recurrence in BRTO using STS group. Abdominal pain occurred more frequently in BRTO using EO than BRTO using STS foam and PARTO (P < 0.05). Procedure time of PARTO was shorter than two conventional BRTOs (P < 0.05).ConclusionsBRTO using STS foam or PARTO is better than BRTO using EO for treatment of gastric varices in terms of complication or procedure time. However, PARTO showed frequent recurrence of gastric varices during the long-term follow-up rather than BRTO.« less
  • Purpose. To develop a new coaxial balloon catheter system and evaluate its clinical feasibility for balloon-occluded retrograde transvenous obliteration (B-RTO). Methods. A coaxial balloon catheter system was constructed with 9 Fr guiding balloon catheter and 5 Fr balloon catheter. A 5 Fr catheter has a high flexibility and can be coaxially inserted into the guiding catheter in advance. The catheter balloons are made of natural rubber and can be inflated to 2 cm (guiding) and 1 cm (5 Fr) maximum diameter. Between July 2003 and April 2005, 8 consecutive patients (6 men, 2 women; age range 33-72 years, mean agemore » 55.5 years) underwent B-RTO using the balloon catheter system. Five percent ethanolamine oleate iopamidol (EOI) was used as sclerosing agent. The procedures, including maneuverability of the catheter, amount of injected sclerosing agent, necessity for coil embolization of collateral draining veins, and initial clinical results, were evaluated retrospectively. The occlusion rate was assessed by postcontrast CT within 2 weeks after B-RTO. Results. The balloon catheter could be advanced into the proximal potion of the gastrorenal shunt beyond the collateral draining vein in all cases. The amount of injected EOI ranged from 3 to 34 ml. Coil embolization of the collateral draining vein was required in 2 cases. Complete obliteration of gastric varices on initial follow-up CT was obtained in 7 cases. The remaining case required re-treatment that resulted in complete obstruction of the varices after the second B-RTO. No procedure-related complications were observed. Conclusion. B-RTO using the new coaxial balloon catheter is feasible. Gastric varices can be treated more simply by using this catheter system.« less
  • We encountered a patient with gastric varix draining not via the usual left suprarenal vein but via the left inferior phrenic vein joining the left hepatic vein. Transfemoral balloon-occluded retrograde transvenous obliteration (BRTO) of the varix was performed under balloon occlusion of the left inferior phrenic vein via the left hepatic vein and retrograde injection of the sclerosing agent (5% of ethanolamine oleate) into the gastric varix. Disappearance of the gastric varix was confirmed on endoscopic examination 2 months later.