Abstract No. 643 Balloon-occluded retrograde transvenous obliteration from pericardial vein to eradicate gastric varices

Abstract

To elucidate the clinical meaning of performing balloon-occluded retrograde transvenous obliteration (BRTO) from pericardial vein (PCV) when it is the main drainage vein of gastric varices. The frequency of PCV drainage, characteristics of patients with PCV drainage, technical and clinical success rates of BRTO from PCV were retrospectively evaluated in 272 patients who underwent BRTO for the treatment of gastric varices from 1998 to 2017 at our hospital. After catheterization of PCV, ethanolamine oleate (EO) was injected from the PCV under balloon occlusion. The main drainage vein of gastric varices was gastro-renal shunt in 258 patients (94.9%, 258/272), inferior phrenic vein in 9 patients (3.3%, 9/272), and PCV in 5 patients (1.8%, 5/272). Patients with PCV drainage consisted of 2 males and 3 females with a median age of 68.0 years (range, 39–71 years). There were no characteristic backgrounds in terms of liver function and cause of liver cirrhosis in these patients. BRTO was technically successful in 3 patients (60%, 3/5), but unsuccessful in the other 2 patients who received BRTO in an early period. The PCV was too narrow to catheterize in a patient, and the PCV was anastomosed to the left pulmonary vein that may cause severe complications by injecting EO in another patient. Gastric varices were completely eradicated in 2 patients (40%, 2/5), and shrunk in a patient (20%, 1/5). Although the frequency PCV drainage of gastric varices is rare, it is important to know this root in order to improve clinical results of BRTO.