Role of percutaneous transhepatic obliteration of varices in the management of hemorrhage from gastroesophageal varices

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

“…[11][12][13][14][15][16][17][18] In conventional PTVE, several embolic materials including cyanoacrylate 16 have been used. However, as these embolic materials were mainly infused into the left gastric vein or other afferent veins, it was difficult to obtain sufficient filling with these embolic materials via the afferent gastric vein into the entire varices.…”

Portal hypertension: a review of portosystemic collateral pathways and endovascular interventions

“…58 Due to the high risk of re-bleeding (37e65%) within a few months after the procedure, PTE has fallen out of favour in recent years. 59 Specific circumstances, such as poor liver function (precluding a TIPS) or lack of systemic access to perform a BRTO, would be the instances where PTE would be used. Multiple embolic agents have been used to perform PTE including gelfoam, metallic coils, absolute alcohol, and sclerosants, such as cyanoacrylate.…”

Nonshunting Procedures for Control of Variceal Bleeding

“…68 PTE of the coronary vein and its collaterals must be seen as a temporizing measure to be used in poor-risk patients refractory to standard medical treatment of vasopressin, tamponade, and sclerotherapy.13,l7,l99 It should not be used for elective cases but may be considered prior to emergency shunt or devascularization procedures. Although initial success rates may be high, the incidence of rebleeding and major complications, including portal vein thrombosis, may ultimately affect the outcome as well as limit the type of future portosystemic shunt surgery that is to be considered.13,73,1 16,138,199,223 In patients with massive ascites, severe coagulopathy or profound liver failure, transumbilical embolization can be performed following catherization of the umbilical vein via a supraumbilical incision performed under local anesthesia.78*79*202.211 All eight patients in whom this procedure was performed died, two deaths being attributed to complications of the procedure and the other six due to the severity of the cirrhosis.202…”