Abstract No. 131 Embolization of parastomal and small bowel ectopic varices utilizing a transhepatic antegrade approach: a case series

Abstract

Ectopic varices (EVs) are abnormally dilated splanchnic veins or portosystemic collaterals that occur anywhere along the gastrointestinal tract. Although EVs comprise a small subset of variceal hemorrhages, EVs are associated with mortality rates reported as high as 40%. The ideal management approach to treating parastomal and small bowel EVs is yet to be established. The purpose of this project is to evaluate the outcomes following percutaneous antegrade transhepatic venous obliteration (PATVO) in patients presenting with active bleeding from parastomal or small bowel EVs. A retrospective review of nine patients who underwent ten PATVO interventions for EVs at our tertiary care institution was performed. Inclusion criteria was age > = 18 years and acute or chronic bleeding from parastomal or small bowel EVs. Technical success was defined as resolution of varices on angiography immediately after embolization. Early clinical success was defined as resolution of bleed for at least 30 days after procedure. Technical success rate was 100% (n = 9), and early clinical success rate was 88.9% (n = 8). Intra- and post-operative complication rate was 0%. Re-bleed rate of 22.2% (n = 2) at a mean of 274.5 days was established after initial PATVO procedure due to unresolved underlying portal hypertension. These patients were successfully treated with TIPS. Within our study population, 22.2% (n = 2) of patients underwent prior surgical interventions for variceal bleeding that resulted in clinical failure and subsequent re-bleeding prior to being referred to interventional radiology. These patients were successively treated with PATVO, resulting in complete technical and early clinical success. PATVO is an effective option for embolization of bleeding from parastomal and small bowel EVs. Given the high technical success rate and satisfactory early clinical success, PATVO should be considered as the primary treatment option prior to attempting TIPS, especially considering these patients have multiple comorbidities often precluding surgical options. Additionally, PATVO is less invasive than TIPS, and demonstrates a lower incidence of complications and faster recovery period. In patients who present with recurrent bleeding despite PATVO due to unresolved portal hypertension, TIPS remains a valid option.