Barbara M. Ryan, Reinhold W. Stockbrugger, J.Mark Ryan

Slides:

Advertisements

Similar presentations

Inferior Vessels of Cat

Advertisements

PORTAL HYPERTENSION & CHRONIC LIVER DISEASE SEAN CHEN ST GEORGE HEPATOBILIARY & PANCREATIC WORKSHOP 31/05/2014.

Interventional Radiology Radiology has provoked from providing purely diagnostic information to therapy, offering effective alternatives in the Rx.

Memorial Sloan Kettering Cancer Center

Total anomalous pulmonary venous connection variants

Percutaneous treatment of symptomatic superior mesenteric vein stenosis using self- expanding nitinol stents L.P. Beyer, W.A. Wohlgemuth, W. Uller, B.

A New Procedure for the Treatment of Extrahepatic Portal Hypertension in Children: Portal Cavernoma-Rex Shunt with Interposition of Grafted Portal Vessel

Intra-abdominal venous flow pathways leading to engorged veins (varices) from portal hypertension. 1, Coronary vein; 2, superior hemorrhoidal veins; 3,

Portal Hypertension.

Portal Hypertension Dr. HAMID HINDI.

Retrieval Stent Filter: Treatment of Budd Chiari Syndrome Complicated With Inferior Vena Cava Thrombosis—Initial Clinical Experience Xin-Wei Han, MD,

Endovascular treatment of renal artery aneurysms and renal arteriovenous fistulas Zhongming Zhang, MD, Min Yang, MD, Li Song, MD, Xiaoqiang Tong, MD,

Volume 135, Issue 5, Pages (November 2008)

Volume 139, Issue 6, Pages (December 2010)

Portal Hypertension: A Pictorial Review of Portosystemic Collateral Pathways and Radiologic Interventions A Mirakhur MD1, MC Ferris MD1, RR Gray MD1, A.

Ultrasound Evaluation of Visceral Veins

Joint Hospital Surgical Grand Round Unusual cause of LGIB

The Hepatic Portal System

Mesenteric Venous Thrombosis

F. Gibson, A. Bodenham British Journal of Anaesthesia

Nonvascular Pediatric Interventional Radiology

Quiz Page October 2014 American Journal of Kidney Diseases

Protecting Patients With Varicose Veins

Khanjan Baxi, BS, Samir K. Shah, MD, Daniel G. Clair, MD

JEFFREY W. FRANK, M. D. , PATRICK S. KAMATH, M. D. , ANTHONY W

Robotic-assisted left renal vein transposition as a novel surgical technique for the treatment of renal nutcracker syndrome Anthony H. Chau, MD, Haidar.

Three-dimensional spiral computed tomographic angiography: An alternative imaging modality for the abdominal aorta and its branches Geoffrey D. Rubin,

Peripherally Inserted Central Catheters and Other Intravascular Devices: How Safe Are They for Hemodialysis Patients? Roman Shingarev, MD, Michael Allon,

EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue: a large U.S. experience over 6 years (with video)

Acute Gastrointestinal Hemorrhage: Radiologic Diagnosis and Management

Matthew C. Hyman et al. JACEP 2016;j.jacep

Christopher T. Healey, MD, Neil Halin, DO, Mark Iafrati, MD

Should the Presence of Spontaneous Portosystemic Shunts Be Implemented to the Model for End-Stage Liver Disease Score for a Better Prediction of Outcome?

Short-Bowel Syndrome Clinical Gastroenterology and Hepatology

Superior Vena Cava Syndrome: Role of the Interventionalist

Uei Pua, FRCR American Journal of Kidney Diseases

Feasibility and safety of endovascular treatment for chronic cerebrospinal venous insufficiency in patients with multiple sclerosis Tommaso Lupattelli,

Long-term central venous access

Iliofemoral stenting for venous occlusive disease

Laparoscopic inferior mesenteric-gonadal vein bypass for the treatment of nutcracker syndrome Danfeng Xu, MD, Yi Gao, MD, Jie Chen, MD, Junkai Wang,

Left renal vein transposition for nutcracker syndrome

Roger A. Orsini, M.D., Bruce E. Jarrell, M.D.

Chylothorax secondary to venous outflow obstruction treated with transcervical retrograde thoracic duct cannulation with embolization and venous reconstruction

Laparoscopic management of celiac artery compression syndrome

Utility of magnetic resonance imaging in establishing a venous pressure gradient in a patient with possible nutcracker syndrome Ari Goldberg, MD, PhD,

EUS-guided coiling of hepatic artery pseudoaneurysm in 2 stages

Diagnosis and endovascular treatment of iliocaval compression syndrome

Transjugular intrahepatic portosystemic shunt for bleeding angiodysplasia-like lesions in portal-hypertensive colopathy Christoph Balzer, Erich Lotterer,

Robotic-assisted left renal vein transposition as a novel surgical technique for the treatment of renal nutcracker syndrome Anthony H. Chau, MD, Haidar.

Transhepatic radiofrequency ablation of a cavotricuspid isthmus–dependent atrial flutter Zahra Jehan Iqbal, MD, Long Cao, MD, Karl Chiang, MD, Sundeep.

Juan A. Oliver, Elizabeth C. Verna Kidney International

Management of Gastric Varices

Three-dimensional spiral computed tomographic angiography: An alternative imaging modality for the abdominal aorta and its branches Geoffrey D. Rubin,

Recurrent variceal bleeding despite endoscopic and medical therapy

Primary Budd-Chiari syndrome: Outcome of endovascular management for suprahepatic venous obstruction Byung-Boong Lee, MD, PhD, Leonel Villavicencio,

Stenting of the venous outflow in chronic venous disease: Long-term stent-related outcome, clinical, and hemodynamic result Peter Neglén, MD, PhD, Kathryn.

Stenting of chronically obstructed inferior vena cava filters

An atypical journey during a “typical” EP case

The early phase of the mesenteric angiogram (A) shows dense contrast filling the splenic artery (SA) and a normal sized spleen. The early phase of the.

Duplication of inferior vena cava and coagulation mutations with left-sided iliofemoral venous thrombosis Mukesh Kumar Garg, MS, DNB, Ambarish Satwik,

Computer-assisted Hydrodynamic Gene Delivery

Yang Liu, MM, Yan Sun, MM, Xing Jin, MD Journal of Vascular Surgery

Criteria for defining significant central vein stenosis with duplex ultrasound Nicos Labropoulos, PhD, DIC, RVT, Marc Borge, MD, Kenneth Pierce, MD, Peter.

Medical management of fecal incontinence

Endovascular treatment of renal artery aneurysms and renal arteriovenous fistulas Zhongming Zhang, MD, Min Yang, MD, Li Song, MD, Xiaoqiang Tong, MD,

Aorta—left renal vein fistula syndrome caused by rupture of a juxtarenal abdominal aortic aneurysm: Novel pathologic mechanism for a unique clinical entity

Douglas A. Simonetto, MD, Mengfei Liu, MD, Patrick S. Kamath, MD

Severe Cyanosis After Kawashima Operation Resulting From Congenital Portosystemic Shunt Yuki Nakamura, MD, Mitsuru Aoki, MD, Ikuo Hagino, MD, Hiromichi.

Susan G. MacLellan-Tobert, M. D. , Frank Cetta, M. D. , Donald J

Volume 135, Issue 5, Pages (November 2008)

Presentation transcript:

A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices Barbara M. Ryan, Reinhold W. Stockbrugger, J.Mark Ryan Gastroenterology Volume 126, Issue 4, Pages 1175-1189 (April 2004) DOI: 10.1053/j.gastro.2004.01.058

Figure 1 Classification of GV. From Sarin et al.8 with permission. Gastroenterology 2004 126, 1175-1189DOI: (10.1053/j.gastro.2004.01.058)

Figure 2 (A ) Normal portal venous blood flow. PV, portal vein; CoV, coronary vein; SpV, splenic vein; SMV, superior mesenteric vein. (B) Portal venous blood flow in the presence of portal hypertension and GRS. Note reversal of flow in the coronary vein resulting in esophageal varices, and reversal of flow in the splenic vein resulting in gastric varices, which decompress via the GRS. Lkid, left kidney; LRV, left renal vein; IVC, inferior vena cava. Gastroenterology 2004 126, 1175-1189DOI: (10.1053/j.gastro.2004.01.058)

Figure 3 (A) Transhepatic splenic venogram shows filling of GV and stenosis (St) of the splenic vein (SP). The pressure gradient across the stenosis was 16 mm Hg. (B) Splenic venogram after stent placement (ST) across the stenosis. The pressure gradient was reduced to 2 mm Hg. The gastric varices no longer fill readily. Gastroenterology 2004 126, 1175-1189DOI: (10.1053/j.gastro.2004.01.058)

Figure 4 (A ) Early-phase portogram of a patient with increased velocities (and turbulence) on Doppler ultrasound shows stenosis of the TIPS (TS) secondary to pseudo-intimal hyperplasia. There is also early filling of EV and GV owing to hepatofugal flow in the coronary vein (C) and splenic vein (SV), respectively. Hepatic vein PPG was 12 mm Hg. (B) Late-phase portogram shows marked filling of the esophageal varices (E) and gastric varices (G). The TIPS stent (T) is well seen. (C ) Very late phase portogram shows GV draining via a spontaneous GRS into the left renal vein (RV). (D) Early-phase portogram postangioplasty of the stenotic TIPS shows resolution of the stenosis (T). Early filling of the EV and GV still are seen. Hepatic vein PPG was 11 mm Hg. Gastroenterology 2004 126, 1175-1189DOI: (10.1053/j.gastro.2004.01.058)

Figure 5 (A) B-RTO. The left renal vein is cannulated via a transjugular or a transfemoral approach. A balloon catheter is inserted and inflated for 30 minutes in the GRS, blocking the main outflow of the varix. Sclerosant (5% ethanolamine oleate mixed with a contrast agent such as iopamidol) then is injected slowly and directly into the varices in a retrograde manner until the GV are filled completely with contrast (controlled fluoroscopically). (B) Balloon-occluded endoscopic injection sclerotherapy. The portal vein is cannulated transhepatically and, if present, a GRS is cannulated transfemorally via the left renal vein. Via the portal vein, the smaller veins supplying the varices are occluded with coils and the main supplying vein also is occluded with a balloon, essentially creating a closed circuit. Endoscopically the varices then are injected with sclerosant. Posttreatment, the catheters remain in situ for 24 hours to permit maximal sclerosis of the varices. G.varix, gastric varix; S.g.vein, short gastric vein; R.g.vein, right gastric vein; L.g.vein, left gastric vein; GR shunt, gastrorenal shunt. Reprinted from Shiba et al.157 with permission. Gastroenterology 2004 126, 1175-1189DOI: (10.1053/j.gastro.2004.01.058)

Figure 6 Proposed algorithm for management of bleeding gastric varices. BO-EIS, balloon-occluded endoscopic injection sclerotherapy. Gastroenterology 2004 126, 1175-1189DOI: (10.1053/j.gastro.2004.01.058)