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Selective Balloon-Occluded Retrograde Sclerosis of Gastric Varices Using a Coaxial Microcatheter System

Koji Takahashi1, Tomonori Yamada1, Hideki Hyodoh2, Taihei Yoshikawa3, Ryuji Katada4, Kenichi Nagasawa1 and Tamio Aburano1

1 Department of Radiology, Asahiakawa Medical College, 2-1-1-1 Midorigaoka-higashi, Asahikawa, Japan, 078-8510.
2 Department of Radiology, Sapporo Medical University, Minami1-nishi 16 Chuo-ku, Sapporo, 060-8543, Japan.
3 Department of Radiology, Sapporo Higashi Tokushukai Hospital, Kita 33-higashi 13-3-21 Higashi-ku, Sapporo, 065-0033, Japan.
4 Department of Radiology, Sapporo Tokushukai Hospital, 18-4-10 Sakaedori, Shiroishi-ku, Sapporo, 003, Japan.



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  		Fig. 1A. —Balloon-occluded retrograde transvenous sclerosis. Drawing shows that in standard balloon-occluded retrograde transvenous sclerosis, balloon catheter is inserted into and inflated at left adrenal vein just above left renal vein (long arrow). After varicography to evaluate anatomic details of gastric varices and position of balloon catheter, sclerosant is injected into entire portion of gastric varices and gastrorenal shunt (shaded area). Embolization of collateral vessels (short arrow) from gastrorenal shunts to systemic circulation is occasionally needed for prevention of flow of sclerosant into systemic circulation in patients for whom varicography has shown prominent collateral vessels. IVC = inferior vena cava.

 


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  		Fig. 1B. —Balloon-occluded retrograde transvenous sclerosis. Drawing shows that coaxial microcatheter (short arrow) is selectively inserted into gastric varices through inflated balloon catheter (long arrow) in balloon-occluded retrograde transvenous sclerosis. Sclerosant is then directly injected into gastric varices (shaded area). Forty minutes after injection of sclerosant, as much of residual sclerosant as possible is withdrawn. IVC = inferior vena cava.

 


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  		Fig. 2A. —Balloon-occluded retrograde sclerosis with coaxial microcatheter in 75-year-old woman with gastric varices associated with liver cirrhosis. Portal phase of superior mesenteric angiogram shows prominent gastric varices (straight arrows) draining into left renal vein (curved arrow). Portal vein trunk is markedly narrowed (arrowheads).

 


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  		Fig. 2B. —Balloon-occluded retrograde sclerosis with coaxial microcatheter in 75-year-old woman with gastric varices associated with liver cirrhosis. Digital radiograph shows microcatheter being advanced into gastric varices through inflated balloon catheter.

 


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  		Fig. 2C. —Balloon-occluded retrograde sclerosis with coaxial microcatheter in 75-year-old woman with gastric varices associated with liver cirrhosis. Portal phase of superior mesenteric angiogram obtained after procedure shows selective obliteration of portion of gastric varices (arrows) that protrude into gastric lumen.

 

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