A Modified Percutaneous Transhepatic Varices Embolization With 2-Octyl Cyanoacrylate in the Treatment of Bleeding Esophageal Varices

Zhang, Chun-Qing; Liu, Fu Li; Liang, Bo; Xu, Hong; Xu, Lin; Feng, Kai; Liu, Zun Chang

doi:10.1097/mcg.0b013e31817ff90f

Cited by 24 publications

(23 citation statements)

References 20 publications

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“…Based on the vascular anatomy of EV, we have had a long‐term interest in performing PTVE with cyanoacrylate to adequately obliterate lower EV and their feeding veins . Previous reports by Smith‐Laing et al .…”

Section: Discussionmentioning

confidence: 99%

“…Cyanoacrylate is a permanent embolization material and when it is infused into the lower esophageal varices (EV) and the vessels which supply the varices, adequate embolization of the varices will be achieved. This modified PTVE technique has been confirmed as an effective and safe method for preventing EV recurrence and rebleeding, while the eradication rate seems to be influenced by operator's skill and the portosystemic hemodynamics in each patient. In some patients cyanoacrylate gathers only in the peripheral vein of gastric cardia and fails to reach the lower EV, leading to a high rate of relapse and rebleeding of EV.…”

Section: Introductionmentioning

confidence: 85%

“…PTVE was performed under radiological guidance, as described previously . Briefly, after transhepatic puncture of an intrahepatic portal vein branch under ultrasonography or fluoroscopy guidance, a 5‐Fr Cobra catheter (Cordis Corporation, Bridgewater, NJ, USA) was introduced into the splenic vein, and splenoportography was performed to evaluate the index varices as well as the feeding vessels and draining veins.…”

Section: Methodsmentioning

confidence: 99%

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Percutaneous transhepatic variceal embolization combined with endoscopic ligation for the prevention of variceal rebleeding

Shu

Tian

et al. 2013

J of Digest Diseases

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 85%

Section: Methodsmentioning

confidence: 99%

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Percutaneous transhepatic variceal embolization combined with endoscopic ligation for the prevention of variceal rebleeding

Shu

Tian

et al. 2013

J of Digest Diseases

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“…19 In addition to TIPS placement, percutaneous trans hepatic varix embolization was performed with spring coils (IMWCE-35-5-5 and MWCE-35-14-6 Nester; Cook Medical, Bloomington, IN) to embolize portosystemic collateral varices. 20 Transjugular intrahepatic portosystemic shunt revision was performed ( Figure 1, A and B) if TIPS dysfunction was diagnosed by color Doppler sonography. The PPG was again measured during TIPS revision.…”

Section: Transjugular Intrahepatic Portosystemic Shunt Percutaneous mentioning

confidence: 99%

Shear Wave Elastography of the Spleen for Monitoring Transjugular Intrahepatic Portosystemic Shunt Function

Gao¹,

Xiao

Zheng

et al. 2016

J of Ultrasound Medicine

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A Pilot Studyhe transjugular intrahepatic portosystemic shunt (TIPS) is used for management of refractory acute variceal hemorrhage and intractable ascites in late-stage liver diseases with portal hypertension. 1 In addition to monitoring the clinical status, it is important to monitor TIPS hemodynamic function objectively. 2,3 Although the portosystemic pressure gradient (PPG) and hepatic venous pressure gradient are still considered the reference standards for diagnosis and monitoring of portal hypertension, they Jing Gao, MD, Xiao Zheng, MS, Yuan-Yi Zheng, MD, Guo-Qing Zuo, MD, Hai-Tao Ran, MD, Yong Ho Auh, MD, Levi Waldron, PhD, Tiffany Chan, MS, Zhi-Gang Wang, MD Received July 6, 2015, Objectives-To assess the feasibility of splenic shear wave elastography in monitoring transjugular intrahepatic portosystemic shunt (TIPS) function.Methods-We measured splenic shear wave velocity (SWV), main portal vein velocity (PVV), and splenic vein velocity (SVV) in 33 patients 1 day before and 3 days to 12 months after TIPS placement. We also measured PVV, SVV, and SWV in 10 of 33 patients with TIPS dysfunction 1 day before and 3 to 6 days after TIPS revision. Analyses included differences in portosystemic pressure gradient (PPG), PVV, SVV, and mean SWV before and after TIPS procedures; comparison of median SWV before and after TIPS procedures; differences in PVV, SVV, and SWV before and at different times up to 12 months after TIPS placement; accuracy of PVV, SVV, and SWV in determining TIPS dysfunction; and correlation between PPG and SWV.Results-During 12 months of follow-up, 23 of 33 patients had functioning TIPS, and 10 had TIPS dysfunction. The median SWV was significantly different before and after primary TIPS placement (3.60 versus 3.05 m/s; P = .005), as well as before and after revision (3.73 versus 3.06 m/s; P = .003). The PPG, PVV, and SVV were also significantly different before and after TIPS placement and revision (P < .001). The PPG and SWV decreased, whereas PVV and SVV increased, after successful TIPS procedures. A positive correlation was observed between PPG and SWV (r = 0.70; P < .001), and a negative correlation was observed between PPG and PVV and SVV (r = -0.65; P < .001). The areas under the receiver operating characteristic curve for PVV, SVV, and SWV in determining TIPS dysfunction were 0.82, 0.84, and 0.81, respectively.Conclusions-Splenic SWV is compatible with splenoportal venous velocity in quantitatively monitoring TIPS function and determining TIPS dysfunction.

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“…Over the past years, Zhang et al developed a modified percutaneous transhepatic embolization of varices (PTVE) with 2-octyl cyanoacrylate (2-OCA), in which 2-OCA was injected into the whole lower esophageal and para-esophageal varices, the submucosal varices and the adventitial plexus of the cardia and fundus, this way, not only the esophageal varices but also the feeders were obliterated sufficiently to prevent variceal recurrence and improve long-term efficacy [37, 38]. In the prospective randomized controlled trial [38], cirrhotic patients with acute or recent esophageal variceal bleeding were assigned randomly to PTVE (52 patients) or EVL (50 patients) groups.…”

Section: Emergency Treatment Of Variceal Hemorrhagementioning

confidence: 99%

Management of Variceal Hemorrhage

Zhang

2009

Gastroen Res

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Variceal hemorrhage is a frequent and lethal complication of portal hypertension. Bleeding occurs in 30%-40% of patients with cirrhosis and varices. The first episode of variceal bleeding is associated with a high mortality as well as a high incidence of rebleeding. Thus, management of variceal hemorrhage should be categorized into 3 phases: primary prophylaxis (prevention of the first episode of bleeding), emergency treatment (management of acute bleeding), and secondary prophylaxis (prevention of re-bleeding). Modalities involved include pharmacological, endoscopic, surgical, interventional radiological therapy and balloon tamponade. This review summarizes the current choices of management during each phase, and concentrates on the following questions, what can we do to prevent the formation and development of varices; how can we predicate the risk of bleeding; what should we do in case of bleeding; what is the first-line therapy; what should we do when current therapy fails; when should we give up and what is the optimal strategy for secondary prophylaxis.

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A Modified Percutaneous Transhepatic Varices Embolization With 2-Octyl Cyanoacrylate in the Treatment of Bleeding Esophageal Varices

Cited by 24 publications

References 20 publications

Percutaneous transhepatic variceal embolization combined with endoscopic ligation for the prevention of variceal rebleeding

Percutaneous transhepatic variceal embolization combined with endoscopic ligation for the prevention of variceal rebleeding

Shear Wave Elastography of the Spleen for Monitoring Transjugular Intrahepatic Portosystemic Shunt Function

Management of Variceal Hemorrhage

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