Abstract
BackgroundCoil-assisted retrograde transvenous obliteration (CARTO) is a modified balloon-occluded retrograde transvenous obliteration (BRTO) technique using coils instead of an indwelling balloon. A method involving two microcatheter systems forming a double access route has been reported. We report a case of CARTO using a steerable microcatheter to successfully treat gastric varices (GV).Case presentationA 79-year-old man was admitted for treatment of intractable GV due to liver cirrhosis. The GV were drained mainly into the left inferior phrenic vein, not the usual gastrorenal shunt. Introducing the balloon catheter to the left inferior phrenic vein was difficult due to mild stenosis between the inferior vena cava and inferior phrenic vein and the shunt angle. A CARTO technique was performed with 5% ethanolamine oleate with iopamidol from a single access route by inverting the steerable microcatheter distal to the coil placement site.ConclusionCARTO has advantages in cases where performing BRTO is difficult. Using a steerable microcatheter simplifies the procedure by reducing the required access routes in CARTO.
Highlights
Balloon-occluded retrograde transvenous obliteration (BRTO) was first described by Kanagawa et al in 1996 (Kanagawa et al 1996)
The use of two microcatheter systems, one each for coil deployment and gelfoam injection, from a double access route has been reported in Coil-assisted retrograde transvenous obliteration (CARTO)
CARTO is expected to have higher material costs than common balloon-occluded retrograde transvenous obliteration (BRTO), which is a disadvantage of the technique compared with BRTO
Summary
Balloon-occluded retrograde transvenous obliteration (BRTO) was first described by Kanagawa et al in 1996 (Kanagawa et al 1996). Lee et al introduced coil-assisted retrograde transvenous obliteration (CARTO) in 2012 and reported on 20 cases of the procedure in 2014 (Lee et al 2014). This technique is a modified BRTO technique which uses coils instead of an indwelling balloon and is advantageous if the shunt is not conducive to balloon placement. Single right femoral venous access was achieved and the guidewire (0.032 or 0.035 in., Radifocus, Terumo, Tokyo, Japan) was introduced into the inferior phrenic vein. The left inferior phrenic vein was successfully accessed using 4 Fr catheter and 2.9 Fr steerable microcatheter (LEONIS Mova; Sumitomo Bakelite, Tokyo, Japan). Complete coil occlusion of the outflow shunt was confirmed, and the inferior phrenic vein was not visualized (Fig. 2b).
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