Usefulness of Intra-procedural Cone-beam Computed Tomography in Modified Balloon-occluded Retrograde Transvenous Obliteration of Gastric Varices

Overview

Journal World J Radiol

Publisher Baishideng Publishing Group

Specialty Radiology

Date 2016 May 10

PMID 27158425

Citations 2

Authors

Edward Wolfgang Lee

Naomi So

Ryan Chapman

Justin P McWilliams

Christopher T Loh

Ronald W Busuttil

Stephen T Kee

Affiliations

Soon will be listed here.

Abstract

Aim: To evaluate whether intra-procedural cone-beam computed tomography (CBCT) performed during modified balloon-occluded retrograde transvenous obliteration (mBRTO) can accurately determine technical success of complete variceal obliteration.

Methods: From June 2012 to December 2014, 15 patients who received CBCT during mBRTO for treatment of portal hypertensive gastric variceal bleeding were retrospectively evaluated. Three-dimensional (3D) CBCT images were performed and evaluated prior to the end of the procedure, and these were further analyzed and compared to the pre-procedure contrast-enhanced computed tomography to determine the technical success of mBRTO including: Complete occlusion/obliteration of: (1) gastrorenal shunt (GRS); (2) gastric varices; and (3) afferent feeding veins. Post-mBRTO contrast-enhanced CT was used to confirm the accuracy and diagnostic value of CBCT within 2-3 d.

Results: Intra-procedural 3D-CBCT images were 100% accurate in determining the technical success of mBRTO in all 15 cases. CBCT demonstrated complete occlusion/obliteration of GRS, gastric varices, collaterals and afferent feeding veins during mBRTO, which was confirmed with post-mBRTO CT. Two patients showed incomplete obliteration of gastric varices and feeding veins on CBCT, which therefore required additional gelfoam injections to complete the procedure. No patient required additional procedures or other interventions during their follow-up period (684 ± 279 d).

Conclusion: CBCT during mBRTO appears to accurately and immediately determine the technical success of mBRTO. This may improve the technical and clinical success/outcome of mBRTO and reduce additional procedure time in the future.

Citing Articles

Evolution of Retrograde Transvenous Obliteration Techniques.

Patel M, Molvar C Semin Intervent Radiol. 2018; 35(3):185-193.

PMID: 30087521 PMC: 6078688. DOI: 10.1055/s-0038-1660796.

Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Gastric Varices: The Role of Intra-Procedural Cone-Beam Computed Tomography.

Gwon D, Ko G, Kwon Y, Yoon H, Sung K Korean J Radiol. 2018; 19(2):223-229.

PMID: 29520179 PMC: 5840050. DOI: 10.3348/kjr.2018.19.2.223.

References

Hirota S, Nakao N, Yamamoto S, Kobayashi K, Maeda H, Ishikura R . Cone-beam CT with flat-panel-detector digital angiography system: early experience in abdominal interventional procedures. Cardiovasc Intervent Radiol. 2006; 29(6):1034-8. DOI: 10.1007/s00270-005-0287-6. View

Yamagami T, Yoshimatsu R, Miura H, Tanaka O, Yasui K, Yagi N . Usefulness of cone-beam computed tomography during balloon-occluded retrograde transvenous obliteration. Minim Invasive Ther Allied Technol. 2013; 22(6):359-63. DOI: 10.3109/13645706.2013.808230. View

Miyayama S, Yamashiro M, Hashimoto M, Hashimoto N, Ikuno M, Okumura K . Comparison of local control in transcatheter arterial chemoembolization of hepatocellular carcinoma ≤6 cm with or without intraprocedural monitoring of the embolized area using cone-beam computed tomography. Cardiovasc Intervent Radiol. 2013; 37(2):388-95. DOI: 10.1007/s00270-013-0667-2. View

Kos S, Burrill J, Weir G, Salat P, Ho S, Liu D . Endovascular management of complex splenic aneurysm with the "amplatzer" embolic platform: application of cone-beam computed tomography. Can Assoc Radiol J. 2010; 61(4):230-2. DOI: 10.1016/j.carj.2009.11.002. View

Ninoi T, Nishida N, Kaminou T, Sakai Y, Kitayama T, Hamuro M . Balloon-occluded retrograde transvenous obliteration of gastric varices with gastrorenal shunt: long-term follow-up in 78 patients. AJR Am J Roentgenol. 2005; 184(4):1340-6. DOI: 10.2214/ajr.184.4.01841340. View

Koizumi J, Hashimoto T, Myojin K, Fukushima T, Ichikawa T, Kagawa T . C-arm CT-guided foam sclerotherapy for the treatment of gastric varices. J Vasc Interv Radiol. 2010; 21(10):1583-7. DOI: 10.1016/j.jvir.2010.05.029. View

Arai H, Abe T, Shimoda R, Takagi H, Yamada T, Mori M . Emergency balloon-occluded retrograde transvenous obliteration for gastric varices. J Gastroenterol. 2005; 40(10):964-71. DOI: 10.1007/s00535-005-1654-4. View

Park J, Cho S, Kee S, Lee E . Vascular plug-assisted retrograde transvenous obliteration of portosystemic shunts for refractory hepatic encephalopathy: a case report. Case Rep Radiol. 2014; 2014:391420. PMC: 3972861. DOI: 10.1155/2014/391420. View

Braak S, Zuurmond K, Aerts H, van Leersum M, Overtoom T, van Heesewijk J . Feasibility study of needle placement in percutaneous vertebroplasty: cone-beam computed tomography guidance versus conventional fluoroscopy. Cardiovasc Intervent Radiol. 2013; 36(4):1120-6. DOI: 10.1007/s00270-013-0598-y. View

10.

Akahoshi T, Hashizume M, Tomikawa M, Kawanaka H, Yamaguchi S, Konishi K . Long-term results of balloon-occluded retrograde transvenous obliteration for gastric variceal bleeding and risky gastric varices: a 10-year experience. J Gastroenterol Hepatol. 2008; 23(11):1702-9. DOI: 10.1111/j.1440-1746.2008.05549.x. View

11.

Kakeda S, Korogi Y, Hatakeyama Y, Ohnari N, Oda N, Nishino K . The usefulness of three-dimensional angiography with a flat panel detector of direct conversion type in a transcatheter arterial chemoembolization procedure for hepatocellular carcinoma: initial experience. Cardiovasc Intervent Radiol. 2007; 31(2):281-8. DOI: 10.1007/s00270-007-9114-6. View

12.

Deschamps F, Solomon S, Thornton R, Rao P, Hakime A, Kuoch V . Computed analysis of three-dimensional cone-beam computed tomography angiography for determination of tumor-feeding vessels during chemoembolization of liver tumor: a pilot study. Cardiovasc Intervent Radiol. 2010; 33(6):1235-42. PMC: 2977071. DOI: 10.1007/s00270-010-9846-6. View

13.

Braak S, van Melick H, Onaca M, van Heesewijk J, van Strijen M . 3D cone-beam CT guidance, a novel technique in renal biopsy--results in 41 patients with suspected renal masses. Eur Radiol. 2012; 22(11):2547-52. PMC: 3472072. DOI: 10.1007/s00330-012-2498-y. View

14.

Gwon D, Ko G, Yoon H, Sung K, Kim J, Shin J . Gastric varices and hepatic encephalopathy: treatment with vascular plug and gelatin sponge-assisted retrograde transvenous obliteration--a primary report. Radiology. 2013; 268(1):281-7. DOI: 10.1148/radiol.13122102. View

15.

Kim M, Um S, Baik S, Seo Y, Park S, Lee J . Clinical features and outcomes of gastric variceal bleeding: retrospective Korean multicenter data. Clin Mol Hepatol. 2013; 19(1):36-44. PMC: 3622854. DOI: 10.3350/cmh.2013.19.1.36. View

16.

Garcia-Pagan J, Barrufet M, Cardenas A, Escorsell A . Management of gastric varices. Clin Gastroenterol Hepatol. 2013; 12(6):919-28.e1. DOI: 10.1016/j.cgh.2013.07.015. View

17.

Loffroy R, Lin M, Yenokyan G, Rao P, Bhagat N, Noordhoek N . Intraprocedural C-arm dual-phase cone-beam CT: can it be used to predict short-term response to TACE with drug-eluting beads in patients with hepatocellular carcinoma?. Radiology. 2012; 266(2):636-48. PMC: 3558876. DOI: 10.1148/radiol.12112316. View

18.

Koizumi J, Hashimoto T, Myojin K, Itou C, Kagawa T, Nishibe T . Balloon-occluded retrograde transvenous obliteration of gastric varices: use of CT-guided foam sclerotherapy to optimize technique. AJR Am J Roentgenol. 2012; 199(1):200-7. DOI: 10.2214/AJR.11.7002. View

19.

Wallace M, Kuo M, Glaiberman C, Binkert C, Orth R, Soulez G . Three-dimensional C-arm cone-beam CT: applications in the interventional suite. J Vasc Interv Radiol. 2008; 19(6):799-813. DOI: 10.1016/j.jvir.2008.02.018. View

20.

Park J, Saab S, Kee S, Busuttil R, Kim H, Durazo F . Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) for Treatment of Gastric Varices: Review and Meta-Analysis. Dig Dis Sci. 2014; 60(6):1543-53. DOI: 10.1007/s10620-014-3485-8. View