Balloon-occlusion Retrograde Transvenous Obliteration Using Gadoteridol As an Alternative Contrast Agent in a Patient with Iodine Allergy

Overview

Journal Intern Med

Specialty General Medicine

Date 2023 Sep 10

PMID 37690844

Authors

Taisei Iwasa

Seiji Adachi

Yusuke Oyama

Yusuke Suzuki

Masatoshi Mabuchi

Hironori Nakamura

Makoto Shimazaki

Shinji Nishiwaki

Takuji Iwashita

Masahito Shimizu

Affiliations

Soon will be listed here.

Abstract

A 70-year-old woman with liver cirrhosis presented with gastric varices and recurrent hepatic encephalopathy. Magnetic resonance imaging (MRI) showed a splenorenal shunt, and balloon-occluded retrograde transvenous obliteration (B-RTO) was indicated but could not be performed due to iodine allergy. We then performed B-RTO using gadoteridol, an MRI contrast medium, instead of iodine contrast and successfully occluded the shunt vessel. After the procedure, hepatic encephalopathy did not recur, and the size of the gastric varices was reduced. This experience may aid in the management of iodine-allergic patients requiring interventional radiological treatment.

References

Zeller T, Muller C, Frank U, Burgelin K, Sinn L, Horn B . Gadodiamide as an alternative contrast agent during angioplasty in patients with contraindications to iodinated media. J Endovasc Ther. 2002; 9(5):625-32. DOI: 10.1177/152660280200900514. View

Kasuga A, Mizumoto H, Matsutani S, Kobayashi A, Endo T, Ando T . Portal hemodynamics and clinical outcomes of patients with gastric varices after balloon-occluded retrograde transvenous obliteration. J Hepatobiliary Pancreat Sci. 2010; 17(6):898-903. DOI: 10.1007/s00534-010-0292-2. View

Rundback J, Shah P, Wong J, Babu S, Rozenblit G, Poplausky M . Livedo reticularis, rhabdomyolysis, massive intestinal infarction, and death after carbon dioxide arteriography. J Vasc Surg. 1997; 26(2):337-40. DOI: 10.1016/s0741-5214(97)70198-8. View

Watanabe A . Portal-systemic encephalopathy in non-cirrhotic patients: classification of clinical types, diagnosis and treatment. J Gastroenterol Hepatol. 2000; 15(9):969-79. DOI: 10.1046/j.1440-1746.2000.02283.x. View

Yoshiji H, Nagoshi S, Akahane T, Asaoka Y, Ueno Y, Ogawa K . Evidence-based clinical practice guidelines for liver cirrhosis 2020. Hepatol Res. 2021; 51(7):725-749. DOI: 10.1111/hepr.13678. View

Jingu A, Fukuda J, Taketomi-Takahashi A, Tsushima Y . Breakthrough reactions of iodinated and gadolinium contrast media after oral steroid premedication protocol. BMC Med Imaging. 2014; 14:34. PMC: 4195268. DOI: 10.1186/1471-2342-14-34. View

Garcia-Tsao G, Abraldes J, Berzigotti A, Bosch J . Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology. 2016; 65(1):310-335. DOI: 10.1002/hep.28906. View

Laine L . Is there a role for combined sclerotherapy and ligation in the endoscopic treatment of gastroesophageal varices?. Gastrointest Endosc. 2017; 86(2):316-318. DOI: 10.1016/j.gie.2017.02.005. View

Hammer F, Goffette P, Malaise J, Mathurin P . Gadolinium dimeglumine: an alternative contrast agent for digital subtraction angiography. Eur Radiol. 1999; 9(1):128-36. DOI: 10.1007/s003300050643. View

10.

Weissenborn K, Giewekemeyer K, Heidenreich S, Bokemeyer M, Berding G, Ahl B . Attention, memory, and cognitive function in hepatic encephalopathy. Metab Brain Dis. 2005; 20(4):359-67. DOI: 10.1007/s11011-005-7919-z. View

11.

Kobayakawa M, Ohnishi S, Suzuki H . Recent development of balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol. 2018; 34(3):495-500. DOI: 10.1111/jgh.14463. View

12.

Grobner T, Prischl F . Gadolinium and nephrogenic systemic fibrosis. Kidney Int. 2007; 72(3):260-4. DOI: 10.1038/sj.ki.5002338. View

13.

Kaufman J, Hu S, Geller S, Waltman A . Selective angiography of the common carotid artery with gadopentetate dimeglumine in a patient with renal insufficiency. AJR Am J Roentgenol. 1999; 172(6):1613-4. DOI: 10.2214/ajr.172.6.10350300. View

14.

Garbuzenko D . Contemporary concepts of the medical therapy of portal hypertension under liver cirrhosis. World J Gastroenterol. 2015; 21(20):6117-26. PMC: 4445090. DOI: 10.3748/wjg.v21.i20.6117. View

15.

Harb T, Laird J, Dieter R, Reddy B, Whitman D, Babrowicz J . Renal artery stenting using gadodiamide arteriography in patients with baseline renal insufficiency. J Endovasc Ther. 2004; 11(5):553-9. DOI: 10.1583/04-1234.1. View

16.

Kanagawa H, Mima S, Kouyama H, Gotoh K, Uchida T, Okuda K . Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration. J Gastroenterol Hepatol. 1996; 11(1):51-8. DOI: 10.1111/j.1440-1746.1996.tb00010.x. View

17.

Koizumi J, Hashimoto T, Myojin K, Itou C, Hara T, Sekiguchi T . Carbon dioxide (CO2) vs iodinated contrast digital subtraction angiography during balloon-occluded retrograde transvenous obliteration (BRTO) using foam sclerosant for gastric varices. J Vasc Interv Radiol. 2012; 23(11):1453-1459.e1. DOI: 10.1016/j.jvir.2012.08.004. View

18.

Amar A, Larsen D, Teitelbaum G . Percutaneous carotid angioplasty and stenting with the use of gadolinium in lieu of iodinated contrast medium: technical case report and review of the literature. Neurosurgery. 2002; 49(5):1262-5; discussion 1265-6. DOI: 10.1097/00006123-200111000-00048. View