Abstract No. 619 Percutaneous transhepatic obliteration of bleeding rectal varices utilizing sodium tetradecyl sulfate foam and interlocking detachable coils: a single-center experience

Abstract

Bleeding rectal varices are a rare but serious complication in patients with cirrhosis and portal hypertension. While medical and endoscopic approaches may be favored at many institutions, percutaneous transhepatic obliteration can be a safe and effective option, and an excellent adjunct or alternative to TIPS for select patients. We report our obliteration technique and clinical outcomes. This review was performed with institutional IRB approval. A retrospective review was performed of all cases at our institution from 2011 to 2017. A total of 5 transhepatic obliteration procedures were performed in 5 patients (3 male/2 female; mean age 60), 4 with active rectal variceal bleeding requiring transfusions and 1 with a history of recurrent rectal variceal bleeding episodes. MELD score was 0-10 in 3 patients, 11-20 in 1 patient, and >20 in 1 patient. In all patients, medical and endoscopic therapies were attempted unsuccessfully prior to variceal obliteration. All cases were performed using sodium tetradecyl sulfate foam and interlocking detachable coils from a percutaneous transhepatic approach. One patient underwent TIPS prior to variceal obliteration. Immediate postprocedural technical success, defined as the lack of continued opacification of rectal varices on postprocedural angiography, was 100%. One patient developed a right flank hematoma and small volume hemoperitoneum discovered at paracentesis on postprocedure-day 2 which did not require intervention. One patient was lost to follow-up following discharge. Over a median clinical follow-up time of 1 month, no patients required repeat endoscopic or endovascular intervention. One patient reported bleeding requiring hospitalization and transfusion at 4 months following the procedure, which subsequently resolved spontaneously. Percutaneous transhepatic obliteration is a safe and effective treatment for rectal varices related to cirrhosis and portal hypertension. Additional follow-up is needed to evaluate the longer-term efficacy for controlling and preventing bleeding.