MESENTERIC VENOUS CANNULATION

Abstract

The acute management of the patient with bleeding esophageal varices continues to represent a difficult therapeutic problem. Occlusion of the coronary veins by either the transhepatic or transjugular route has received increasing attention. These procedures, however, are often difficult, prolonged, and associated with a definite complication rate particularly that of portal vein thrombosis. We would like to introduce the concept of a combined radiological and surgical approach to the embolization of bleeding esophageal varices. Within the angiographic suite under sterile conditions a minilaparotomy is performed. A loop of proximal jejunum is exteriorized and its mesenteric vein cannulated. By utilizing fluoroscopic control a guidewire and then a catheter is advanced to the junction of the superior mesenteric vein with the portal vein. The coronary vein is then selectively catheterized and then occluded with embolic agents. The catheter is removed and a ligature is placed over the puncture site. Because of the relative straight line approach from the mesenteric vein to the coronary vein, minimal catheter manipulation is required. The procedure is relatively easy to accomplish and in two successive patients required less than 1 1/2 hours. Catheter manipulation within the portal vein is not necessary. Although infection of ascitic fluid remains a potential risk, the speed and ease of the procedure indicate continued investigation of this therapeutic approach in the acute management of patients with bleeding esophageal varices.