Gastric Coronary Vein Research Articles

Outcomes of Transjugular Intrahepatic Portosystemic Shunt and Gastric Coronary Vein Embolization for Variceal Bleeding in Cirrhotic Portal Hypertension.

Purpose: To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with gastric coronary vein embolization (GCVE) for cirrhotic portal hypertensive variceal bleeding and compare outcomes of first-line with second-line treatment, coil with glue, and single-covered with double stents.Methods: Fifteen patients received TIPS plus GCVE as the first-line treatment for secondary prophylaxis of variceal bleeding, and 45 received it as second-line treatment. Preoperative and postoperative quantitative variables were compared using a paired t test. The incidence of survival rate, re-bleeding, hepatic encephalopathy, and shunt dysfunction were analyzed using the Kaplan-Meier method.Results: The portal venous pressure was significantly decreased from 39.0 ± 5.0 mm Hg to 22.5 ± 4.4 mm Hg (P≤0.001) after TIPS treatment. After 1, 3, 6, 12, 18, and 24 months re-bleeding rates were 1.6%, 3.3%, 6.6%, 13.3%, 0%, and 0%, respectively. Shunt dysfunction rates were 5%, 0%, 10%, 16.6%, 1.6%, and 5%, respectively. Hepatic encephalopathy rates were 3.3%, 1.6%, 3.3%, 6.6%, 0%, and 0%, respectively. And survival rates were 100%, 100%, 100%, 96.6%, 93.3%, and 88.3% respectively. In comparative analysis, statistically significant differences were seen in re-bleeding between the first-line and second-line treatment groups (26.6% vs 24.4%, log-rank P=0.012), and survival rates between single-covered and double stent (3.7% vs 16.1%, log-rang (P=0.043).Conclusion: The results suggest that TIPS combined with GCVE is effective and safer in the treatment of cirrhotic portal hypertensive variceal bleeding. The use of TIP plus GCVE as first-line treatment, may be preferable for high-risk re-bleeding, and more than 25 mm Hg portal venous pressure with repeated variceal bleeding. However, the sample size was small. Therefore, large, randomized, controlled, multidisciplinary center studies are needed for further evaluation.

Predictors of Shunt Dysfunction and Overall Survival in Patients with Variceal Bleeding Treated with Transjugular Portosystemic Shunt Creation Using the Fluency Stent Graft

Transjugular intrahepatic portosystemic shunt (TIPS) is an established method for portal hypertension. This study was to investigate the long-term safety, technical success, and patency of TIPS, and to determine the risk factors and clinical impacts of shunt dysfunction. A total of 154 consecutive patients undergoing embolotherapy of gastric coronary vein and/or short gastric vein and TIPS creation were prospectively studied. Follow-up data included technical success, patency and revision of TIPS, and overall survival of patients. During the study, the primary and secondary technical success rates were 98.7% and 100%, respectively. Sixty-three patients developed shunt dysfunction, 30 with shunt stenosis and 33 with shunt occlusion. The cumulative 60-month primary, primary assisted, and secondary patency rates were 19.6%, 43.0%, and 93.4%, respectively. The cumulative 60-month overall survival rates were similar between the TIPS dysfunction group and the TIPS non-dysfunction group (68.6% vs. 58.6%, P = .096). Baseline portal vein thrombosis (P < .001), use of bare stents (P = .018), and portal pressure gradient (PPG) (P = .020) were independent predictors for shunt dysfunction, hepatocellular carcinoma (P < .001), and ascites (P = .003) for overall survival. The accuracy of PPG for shunt dysfunction was statistically significant (P < .001), and a cutoff value of 8.5 had 77.8% sensitivity and 64.8% specificity. The long-term safety, technical success, and patency of TIPS were good; baseline portal vein thrombosis, use of bare stents, and PPG were significantly associated with shunt dysfunction; shunt dysfunction has little impact on patients' long-term survival because of high secondary patency rates.

Preventing anastomotic complications: early results of laparoscopic gastric devascularization two weeks prior to minimally invasive esophagectomy.

Laparoscopic gastric devascularization (LGD) is an innovative method to improve gastric conduit perfusion and improve anastomotic healing following esophagectomy. This study reports our early experience with LGD performed two weeks prior to minimally invasive esophagectomy (MIE) with intrathoracic anastomosis. We performed a retrospective review of all patients who underwent LGD prior to minimally invasive Ivor Lewis esophagectomy between August 2014 and July 2015 at a large academic medical center. LGD included staging laparoscopy with division of the short gastric vessels, left gastric artery and coronary vein, and posterior gastric attachments. Patient demographics, comorbid conditions, clinical stage, use of neoadjuvant chemoradiation, perioperative events, length of hospital stay, 60-day readmission, and complications were collected and analyzed. Thirty patients underwent LGD prior to minimally invasive Ivor Lewis esophagectomy, and 21 (70%) received neoadjuvant chemoradiation. LGD was performed a median of 14.5 (9-42) days prior to esophagectomy. Median operative time was 39 (18-56) minutes, and median length of stay was 0 (0-1) days. There were no complications or readmissions following LGD. MIE was completed laparoscopically in 93% of patients; two patients required conversion to an open procedure due to mediastinal inflammation following neoadjuvant chemoradiation. Five patients (17%) were readmitted within 60days of surgery: one (3%) patient with an anastomotic leak, two (7%) with pneumonia, and two (7%) with post-operative nausea and vomiting. One patient (3%) expired following an anastomotic leak that required reoperation, and no patients developed an anastomotic stricture during the study period. LGD with delayed esophageal resection and reconstruction can be safely performed two weeks prior to MIE with minimal morbidity. The low rate of anastomotic leak (3%) and absence of anastomotic strictures in this series suggest that this approach may successfully improve gastroesophageal anastomotic healing and reduce the rate of anastomotic complications reported with single-stage approaches.

Clinical efficacy of splenectomy combined with coronary-caval shunt in treatment of portal hypertension

Objective To investigate the clinical efficacy of splenectomy combined with coronary-caval shunt in treatment of portal hypertension (PHT). Methods The retrospective descriptive study was conducted. The clinical data of 21 patients with PHT who underwent splenectomy combined with coronary-caval shunt at the First Affiliated Hospital of Xi'an Jiaotong University from January 2001 to December 2015 were collected. Observation indicators included (1) operation situations, changes of pre- and post-operative portal hemodynamics including operation time and volume of intraoperative blood loss, diameter and blood flow velocity of portal vein (PV), gastric coronary vein and superior mesenteric vein (SMV). (2) Clinical indexes in perioperative period (before operation, at postoperative 1 week and 1 month): ① blood routine test: the counts of red blood cell (RBC), white blood cell (WBC) and platelet (PLT), ② liver function: Child-Pugh score, alanine transaminase (ALT), total bilirubin (TBil), albumin (Alb), extended time of prothrombin time (PT) and international normalized ratio (INR). (3) Follow-up: postoperative 1-, 3-, 5-year complications [upper gastrointestinal re-bleeding, peritoneal effusion, hepatic encephalopathy, hepatic failure, portal vein thrombosis (PVT) and anastomotic stoma thrombosis]. The follow-up using outpatient examination and telephone interview was regularly conducted once every 3 months within postoperative 1 year and once every 6 months after postoperative 1 year up to March 2016 or end of follow-up (death). Measurement data with normal distribution were presented as ±s. The comparison of different time-point was analyzed by the repeated measures ANOVA and Student t test. Measurement data with sknewed distribution were presented as M (range). Results (1) Operation situations and changes of pre- and post-operative portal hemodynamics: 21 patients underwent successful splenectomy combined with coronary-caval shunt, including 19 receiving splenic vein bypass combined with anastomosis of gastric coronary vein and inferior vena cava and 2 receiving anastomosis of gastric coronary vein and inferior vena cava. Operation time, volume of intraoperative blood loss were (187±33)minutes and (233±114)mL. Diameter and blood flow velocity of PV, gastric coronary vein and SMV were (1.39±0.20)cm, (0.66±0.15)cm, (0.74±0.32)cm, (11.2±3.4)cm/s, (6.6±1.3)cm/s, (7.0±2.2)cm/s before operation and (1.36±0.22)cm, (0.42±0.11)cm, (0.81±0.23)cm, (10.4±2.5)cm/s, (8.2±2.5)cm/s, (6.9±2.4)cm/s after operation, respectively, showing no statistically significant difference in the diameter and blood flow velocity of PV and SMV before and after operation (t=0.46, -0.81, 0.87, 0.14, P>0.05)and with statistically significant differences in the diameter and blood flow velocity of gastric coronary vein before and after operation (t=5.91, -2.60, P 0.05). There were statistically significant differences in the ALT and extended time of PT (F=7.97, 4.37, P<0.05)and in the ALT and extended time of PT between 1 week postoperatively and before operation (t=3.23, 2.21, P<0.05). (3) Follow-up: 21 patients were followed up for 3-168 months with a median time of 37 months. During follow-up, 3 patients were dead. One, 1, 2 patients were complicated with upper gastrointestinal re-bleeding at postoperative 1, 3, 5 years and received hemostatic therapy under endoscopy, and then 2 were dead. Three, 2 and 2 patients had peritoneal effusion and were improved by symptomatic treatment. One patient had hepatic encephalopathy and hepatic failure at postoperative 5 years and was dead after conservative treatment. PVT and anastomotic stoma thrombosis at postoperative 1, 3, 5 years were detected in 2, 2, 1 and 2, 1, 1 patients, with anticoagulant therapy, and 1 patient received vascular recanalization. Conclusion Coronary-caval shunt is a highly selective portosystemic shunt, it can significantly down regulate the regional pressure while ensure the normal blood flow of liver and decrease the rate of rebleeding, hepatic encephalopathy and thrombosis, meanwhile, it might be a potential therapy in management of PHT. Key words: Portal hypertension; Coronary-caval shunt; Upper gastrointestinal hemorrhage

Reinsertion of the gastric coronary vein to avoid venous gastric congestion in pancreatic surgery

Reinsertion of the gastric coronary vein to avoid venous gastric congestion in pancreatic surgery

Gastroesophageal varices (bleeding) and splenomegaly: the initial manifestations of some pancreatic body and tail carcinoma.

Gastroesophageal varices (bleeding) and splenomegaly: the initial manifestations of some pancreatic body and tail carcinoma.

Hepatobiliary and Pancreatic: Hepatocellular carcinoma supplied by portal blood after repeated transcatheter arterial chemoembolization

Hepatocellular carcinoma is the fifth most common cancer worldwide and the most common malignant tumor of the liver. Transarterial chemoembolization (TACE) is widely used in the treatment of liver tumors and has become the preferred treatment for patients with hepatocellular cancer who are not suitable for surgical or ablative therapies. The technique is based on the observation that most hepatocellular carcinomas are very vascular tumors with a blood supply that is largely or solely derived from the hepatic artery. The procedure permits the local administration of relatively high concentrations of chemotherapeutic drugs and, in addition, impairs the viability of the tumor by reducing its blood supply. Although TACE can decrease the size of the tumor in up to 70% of patients, there is debate as to the optimal chemotherapeutic drug, the method of embolization and the use of newer products such as drug-eluting beads. Although TACE can be repeated on a number of occasions, a potential issue is that occlusion of the arterial blood supply may lead to nourishment of the tumor by portal blood. An example of this phenomenon is illustrated below. A male, aged 69, was admitted to our hospital because of refractory ascites. He was known to have hepatitis B and had been diagnosed with hepatocellular carcinoma 4 years previously. At the time of diagnosis, hepatic arteriography showed that the tumor was supplied by a branch of the right hepatic artery (Figure 1). He was subsequently treated by TACE and had repeat procedures on five occasions. Prior to admission, ascites had increased in severity with a poor response to diuretics and salt restriction. Blood tests revealed a hemoglobin of 76 g/l with minor changes in liver function tests and a normal serum level of alpha fetoprotein. Peritoneal fluid was a transudate (serum-fluid albumin gradient >1.1 g/dl; 11 g/l) and was repeatedly negative for malignant cells. Arterial portography using a computed tomography scan showed signs of portal hypertension and blood flow to the tumor that contained iodized oil (Figure 2 left). Subsequently, the patient had hepatic arteriography and was treated with a transjugular intrahepatic portosystemic shunt (TIPS). Hepatic angiography was entirely normal but direct portal venography prior to insertion of the shunt revealed tumor staining and a prominent gastric coronary vein (Figure 2 right). The TIPS procedure was associated with improvement in ascites.

Complex Vascular Reconstruction Using Donor's Vessel Grafts in Orthotopic Liver Transplantation

The vascular abnormalities of recipients are associated with reconstructive difficulties with an increased risk of postoperative complications. We performed an orthotopic liver transplantation that required a complex vascular reconstruction using donor vascular grafts. A patient with hepatitis B virus cirrhosis received a liver from a brain-dead donor. Dynamic computed tomography revealed complete obstruction of the portal vein due to thrombosis as well as narrowing of the hepatic arteries. We employed orthotopic liver transplantation using the piggy-back technique with complex reconstruction of the portal vein and the hepatic arteries. For portal vein reconstruction, we used the donor's iliac vein as an interpositional conduit from the recipient's gastric coronary vein to graft the portal vein. The hepatic arteries of the graft were reconstructed at the back-table before anastomosis to the side of superior mesenteric artery using an interpositional conduit of the donor's external iliac artery. All postoperative studies revealed good graft function with an excellent blood flow through all vascular anastomoses during the first year postoperatively.

The classification of anatomic variations in the perigastric vessels by dual-phase CT to reduce intraoperative bleeding during laparoscopic gastrectomy

Laparoscopy-assisted distal gastrectomy (LADG) is a less invasive alternative compared with an open procedure. However, it is difficult to obtain a full-view image and to estimate the three-dimensional (3D) relationships between organs during laparoscopic procedures. Determining the vascular anatomy by 3D CT imaging has been shown to play a critical role in reducing the risks associated with laparoscopic gastric cancer surgery. The purpose of this study was to evaluate the clinical anatomic variations and to estimate its positive contribution in obtaining less intraoperative bleeding. Scanning was performed using a 64-row MDCT scanner. Three-dimensional CT images in the arterial and portal phase were reconstructed and fused together using the volume-rendering technique. The intraoperative bleeding findings were compared between two periods. The anatomic variations of the celiac trunk were divided into six types. There were 159 patients with Adachi's type I, type II=8, type III=1, type IV=1, type V=2, type VI=3, and other=1. The inflows of the left gastric coronary vein (LCV) were divided into three types. The LCV flowed into the portal vein (PV) in 79 patients, into the splenic vein (SpV) in 65, and into the junction of these two veins in 27. The splenic artery was divided into flat type and curved type, and 65 cases (37%) showed the flat type. Intraoperative bleeding was significantly less between 2007 and 2008, in which the operations were performed without first making a 3D anatomy study, than in 2009, in which 3D anatomy studies were made and analyzed before surgery in all patients. Dual-phase 3D CT is a useful and essential modality to visualize the precise anatomy around the stomach. As a result, by comparing 3D CT images with our classifications, it is believed that any surgeons may reduce the degree of intraoperative blood loss.

Laparoscopic Splenectomy and Periesophagogastric Devascularization with Endoligature for Portal Hypertension in Children

Bleeding from esophagogastric varices is an importment complication of portal hypertension. Recently, significant progress in laparoscopic technology has enabled the devascularization of the lower esophagus and upper stomach in a less invasive way. In this article, we report our preliminary experience with laparoscopic splenectomy and periesophagogastric devascularization by endoligature and its effectiveness for bleeding varices with hypersplenism in children. Six children with bleeding portal hypertension and developed severe thrombocytopenia and/or leukopenia underwent laparoscopic splenectomy and selective pericardial devascularization by using silk endoligature combined with a Harmonic Scalpel (Ethicon Endosurgery, Cincinnati, OH). The patients included 5 males and 1 female, who ranged in age from 8 to 17 years. After a massive splenectomy was performed, we devascularized the periesophagogastric collateral vessels and perforating veins of the upper stomach to the level of the incisura angularis and the lower esophagus 5 or 6 cm away from the esophagocardia junction. The stem of the gastric coronary vein and paraesophageal collateral veins were not dissected in order to reserve portal blood flow toward the azygous shunt. All the procedures were completed successfully under a whole laparoscope. The operative time ranged from 180 to 270 minutes. Intraoperative blood loss was estimated to be from 80 to 200 mL. None of the patients required a blood transfusion. There were no significant complications either intra- operatively or postoperatively, and all patients had returned to usual activity by 5 days. Postoperative platelet count and white blood cell count increased in individual patients. The data were statistically significant (p = 0.006 and 0.002, respectively). During a postoperative follow-up period of 8-40 months, all children were asymptomatic, with improved growth and hematology and no rebleeding, sepsis, or encephalopathy. Laparoscopic massive splenectomy with selective periesophagogastric devascularization is a feasible, effective, and safe surgical procedure and has all the benefits of minimally invasive surgery. It offers a new alternative modality for children with bleeding portal hypertension and hypersplenism.

Technique of Open Ivor Lewis Esophagectomy

Technique of Open Ivor Lewis Esophagectomy

Percutaneous transhepatic varices embolization with cyanoacrylate in the treatment of varices

To test the safety and validity of percutaneous transhepatic variceal embolization (PTVE) with tissue adhesive cyanoacrylate. PTVE with cyanoacrylate was performed on 92 patients with gastroesophageal varices, 53 males and 39 females, aged 62.5 (7-84): cyanoacrylate was injected into the varices and the afferent veins. Endoscopy and CT were performed to evaluate the embolization. PTVE was successfully completed in 89 of the 92 patients with a technical success rate of 96.7%, and 3 patients died within 1 month. Among the other 86 patients 3 types of cyanoacrylate embolization were achieved: embolization of coronary vein, vessels around gastric fundus, and variceal lower esophagus veins in 40 patients, embolization of coronary vein, gastric fundus and pericardial varices in 33 patients, and embolization of sole gastric coronary vein stem in 13 patients. Acute variceal bleeding in 18 patients was immediately arrested after the procedure, with an acute bleeding control rate of 100%. Eighty-six patients were followed up for 31.5 (6-52) months. The general variceal recurrence rate was 14.1% (10/71), and the variceal recurrence rate of the coronary vein embolization group was 100% (2/2), significantly higher than those of the groups of esophagus and fundus embolization and gastric fundus and cardia varices embolization [7.5% (3/40) and 17.2% (5/29) respectively, P = 0.006]. The general rebleeding rate was 16.3% (14/86), and the rebleeding rates of the group of coronary vein embolization was 69.2% (9/13), significantly higher than those of the groups of esophagus and fundus embolization and gastric fundus and cardia varices embolization [7.5% (3/40) and 15. 2% (5/33) respectively, P = 0.0092]. No obvious ectopic embolization was found. The mortality was 24.7% (22/89). The cause of rebleeding in coronary vein embolization was mainly recurrent variceal bleeding, whereas that in the group of fundus and esophagus variceal embolization was mainly hypertensive gastropathy. PTVE with cyanoacrylate is safe and effective for the obliteration of gastroesophageal varices in cirrhotic patients.

Partial portacaval shunt with H-grafts to treat portal hypertension

Partial portosystemic shunts have been popularized because of a reported low rate of mortality and morbidity (especially encephalopathy, liver failure and occlusion). The results of partial portacaval shunts [small-diameter expanded polytetrafluoroethylene (ePTFE) H-graft portacaval shunt] were retrospectively reviewed to evaluate the clinical efficacy in the treatment of portal hypertension. Forty-three patients with portal hypertension were treated by small-diameter H-graft of ePTFE portacaval shunt from May 1995 to April 2006. Thirty-three had externally ringed grafts and ten had non-ringed ones. Ten had grafts of 10 mm in diameter and 33 had grafts of 8 mm. The left gastric artery and coronary vein were ligated in all the cases. Six had pericardial devascularization and splenectomy was performed in 42. An average decrease of free portal pressure (FPP) from (33.24 ± 4.78) cmH2O before shunting and (13.65 ± 5.65) cmH2O after shunting was observed. The portal blood flow was reduced by one-third of that before shunt. Thirty-eight patients survived and no upper gastro-intestinal rebleeding occurred in the follow-up period (50.5 months in average). Two were out of contact. Color Doppler ultrasonography and/or portography revealed the shunts were patent in 38 cases and were occluded in three cases (3/41, 7.3%). Encephalopathy developed in five cases (5/41, 12.2%). Partial (small-diameter ePTFE H-graft) portacaval shunting can reduce the portal pressure effectively. Majority of the hepatic flow from the portal vein can be maintained adequately. The shunts with reinforced grafts can keep a higher rate of patency. The morbidity of encephalopathy was lower than those with total shunt. The partial portacaval shunt is effective in preventing recurrent variceal bleeding.

Dual-Phase 3D CT Angiography During a Single Breath-Hold Using 16-MDCT: Assessment of Vascular Anatomy Before Laparoscopic Gastrectomy

In this study, we evaluated the efficacy of dual-phase 3D CT angiography (CTA) during a single breath-hold using 16-MDCT in the assessment of vascular anatomy before laparoscopic gastrectomy. The study involved 20 consecutive patients (10 men, 10 women; mean age, 59 years) scheduled for laparoscopic gastrectomy for the treatment of early gastric cancer. A dual-phase contrast-enhanced CT scan using 16-MDCT was obtained before laparoscopic gastrectomy. After rapid infusion of a nonionic contrast agent, arterial and venous phase scans were obtained serially with an interval of 15 sec during a single breath-hold of 31 sec. Three-dimensional CTA images in the arterial phase (3D CT arteriography) and venous phase (3D CT venography) were individually reconstructed using the volume-rendering technique, and then the images were fused together. We evaluated the detectability of the celiac trunk, left gastric artery (LGA), right gastric artery (RGA), left gastric coronary vein (LCV), Henle's gastrocolic trunk, right gastroepiploic vein (RGEV), and accessory right colic vein on 3D CTA to compare with surgical findings. In all 20 patients, 3D CT arteriography and venography clearly showed the celiac trunk, LGA, RGA, Henle's gastrocolic trunk, RGEV, and accessory right colic vein, which were correctly identified during surgery. The branching pattern of the celiac trunk was classified as Michels type I in 19 patients and Michels type II in one patient. Imaging showed the RGA originating from the proper hepatic artery (PHA) in nine patients; from the gastroduodenal artery (GDA) in seven patients; and from the left hepatic artery (LHA) in four patients. In 12 patients, the LCV joined the portal vein (PV) and in eight, the splenic vein (SV). In all patients, the accessory right colic vein joined the RGEV, and Henle's gastrocolic trunk proximal to the joining point flowed to the superior mesenteric vein (SMV). In all 20 patients, the fused image simultaneously showed arteries and veins around the stomach, with no mismatch between the arterial and venous phase images. In 10 patients, the LCV joined the PV after running along the dorsal side of the PHA, common hepatic artery (CHA), or splenic artery (SA). In eight patients, the LCV joined the SV after running along the ventral side of the PHA, CHA, or SA. In two patients, the LCV joined the PV after running along the ventral side of the CHA, which correlated with the surgical findings. Both the sensitivity and positive predictive values of 3D CTA revealed 100% correct identification of the celiac trunk, LGA, RGA, LCV, Henle's gastrocolic trunk, RGEV, and accessory right colic vein. Dual-phase 3D CTA using 16-MDCT clearly revealed individual arteries and veins around the stomach before laparoscopic gastrectomy. The fused image of 3D CT arteriography and venography during a single breath-hold enabled the simultaneous assessment of arteries and veins before laparoscopic gastrectomy.

Glue for gastric varices: some sticky issues

Glue for gastric varices: some sticky issues

Immunohistochemical analysis of growth factor expression and localization in gastric coronary vein of cirrhotic patients

This study was designed to investigate the expression and localization of PDGF, bFGF, EGF, and TGF alpha in gastric coronary vein of cirrhotic (n = 30) and non-cirrhotic patients (n = 10) using immunohistochemical technique. The strongly positive immunostaining rate were 93%, 89%, 70% and 68% respectively in cirrhotic patients. The immunostaining was negative in non-cirrhotic patients. The damage to endothelium, hypertrophy and hyperplasia of vascular smooth muscle cells and vascular remodeling were seen in gastric coronary vein of cirrhotic patients. These results suggested that gastric coronary vein could produce growth factor during cirrhosis, the growth factor can act on the vascular function and/or structure via autocrine-paracrine mechanism.

Portal hypertensive vascular lesions.

The aim of present study is to assess the pathological changes of gastric coronary vein in cirrhotic patients (n = 30) by immunohistochemical and morphological observation. The damage to endothelium, hypertrophy and hyperplasia of smooth muscle and increament of ECM were found in gastric coronary vein of cirrhotic patients. The vessel wall hardened and thickened with decrease of elasticity. The results showed that the portal hypertension could accompany with portal hypertensive vascular lesions.

Systemic dissemination of ethanolamine oleate after injection sclerotherapy for esophageal varices.

Sclerotherapy for esophageal varices was performed on six patients for a total of 16 injections. The sclerosant contained 5% ethanolamine oleate and technetium Tc 99m sodium pertechnetate solution at the volume ratio of 9:1. At each injection session 5 to 20 mL of this solution was injected into one varix. The distribution of the injected material was observed by a scintillation camera. Systemic dissemination of the sclerosant through the portal vein was demonstrated in five procedures, in which the injections were correctly intravenous. In three dogs 4 mL of 5% ethanolamine oleate made from oleic acids labeled with iodine 131 was injected into the gastric coronary vein. Most of the substance injected was washed out within five minutes, and systemic dissemination became evident.

Isobutyl 2-cyanoacrylate (bucrylate) in obliteration of gastric coronary vein and esophageal varices

Percutaneous transhepatic portography was performed in 22 patients with liver cirrhosis and portal hypertension. All patients had bled or were bleeding from presumed esophageal varices. One or more veins feeding esophageal varices were occluded with bucrylate. Follow-up examination in eight patients 1-12 months later showed recanalization of previously obliterated veins in six; however, these veins were markedly smaller than before the procedure. In patients where veins were still occluded, new veins had opened up and carried blood to the esophageal varices, which were filled to a lesser degree than before. In our experience, bucrylate is superior to Gelfoam, thrombin, and Etolein in producing venous occlusion.

Percutaneous, transhepatic thrombosis of the coronary vein in the treatment of bleeding oesophageal varices (author's transl)

Percutaneous, transhepatic catheterisation of the portal vein in order to occlude the gastric coronary vein was carried out in six patients with bleeding oesophageal varices. Bleeding stopped in three patients, but in the other three ceased only temporarily. Complications were one pleural effusion and one haemothorax. At autopsy, marginal portal vein thrombosis was found in two cases. The indication for this procedure is the presence of bleeding from oesophageal varices which cannot be controlled by conservative means in a patient unfit for operation. It provides an opportunity for carrying out a decompression shunt operation in the interva between the bleeds.