8:00 AM; Abstract No. 165 - Vascular plug-assisted retrograde transvenous obliteration for the treatment of gastric varices and hepatic encephalopathy

Abstract

Purpose To evaluate the technical and clinical safety and the efficacy of Amplatzer Vascular Plug (AVP)-assisted retrograde transvenous obliteration (PARTO) for the treatment of gastric varices (GV) and hepatic encephalopathy (HE). Materials and Methods From April 2009 to December 2011, we evaluated 20 patients (16 men and four women; mean age, 58 years; range, 47-79 years) who had undergone PARTO, 13 of whom had GV and seven who had HE. After retrograde transvenous placement of an AVP into the left adrenal vein, subsequent gelfoam embolization of both the gastrorenal shunt and the GV was performed. Results Placement of the AVP and subsequent gelfoam embolization were technically successful in all 20 patients. There were no procedure-related complications. Follow-up computed tomography (CT) obtained within one week after PARTO showed complete thrombosis of the GV and gastrorenal shunts in all patients. The clinical symptoms of HE were completely resolved in all seven patients with HE and the mean serum NH3 level, which was 127.4 umol/l ± 58 before PARTO, decreased significantly, to 28.1 umol/l ± 9.8, within one week after PARTO (p = 0.002). The clinical success rate was 100%. Improvement in the Child-Pugh score was observed in 12 of 18 patients (66.7%) at one month after PARTO. The mean follow-up period after PARTO was 422 days (range, 170-1168 days). Eighteen patients who had more than a two-month follow-up period, showed complete obliteration of the GV as well as the gastrorenal shunts on both CT and endoscopy. In these 18 patients, four (22.2%) experienced worsening of their esophageal varices at a mean of 9.4 months (range; 1-25 months) after PARTO. There were no cases of variceal bleeding or HE during a mean follow-up period of 422 days (range, 170-1168 days). Conclusion Our preliminary results suggest that PARTO is technically simple and safe and seems to be clinically effective for the treatment of GV and HE. We therefore believe that PARTO results in complete blockage of the gastrorenal shunt with a very high success rate. PARTO also has the potential to become a standard treatment for GV associated with a gastrorenal shunt either in patients with GV or in patients with HE.