Successful Embolization of Bleeding Ileal Varices with N-butyl Cyanoacrylate via a Recanalized Paraumbilical Vein

Abstract

A 48-year-old woman with alcoholic liver cirrhosis was admitted to our hospital because of hematochezia and severe anemia. She had been hospitalized many times over the past year for hematochezia of unknown etiology. Contrast-enhanced CT demonstrated ileal varices, which were fed by several ileal veins. These feeding veins were selectively embolized with N-butyl cyanoacrylate (NBCA) via a recanalized paraumbilical vein. The paraumbilical vein instead of the portal vein was punctured to decrease the risk of bleeding complications because she had coagulopathy and ascites. We consider antegrade embolization of ileal varices with NBCA to be a feasible and effective treatment. Access via a paraumbilical vein is an alternative to the transhepatic approach.Level of Evidence Level V, case report.

Embolization of a paraumbilical shunt by the transparaumbilical venous approach and one-sheath inverse method: A case report

“…A recanalized umbilical vein has been reported to occur in more than 20% of patients with portal hypertension [8] . Previous case reports have demonstrated the usefulness of the transparaumbilical venous approach for embolization of gastroesophageal and ectopic varices due to cirrhosis [3] , [4] , [5] , [6] , [7] . The benefits of the transparaumbilical venous approach include reduced invasiveness and enhanced accessibility to target vessels, compared with other approach routes (eg, percutaneous transhepatic, transjugular, transfemoral, and mesenteric venous routes).…”

“…Approaches for embolization of a portosystemic shunt include percutaneous transhepatic, transjugular, transfemoral, transparaumbilical, and mesenteric venous routes. A percutaneous approach to the portal venous system via the paraumbilical vein has been reported [3] , [4] , [5] , [6] , [7] ; however, it remains unfamiliar to many clinicians, compared with other routes. We describe a patient who exhibited chronic hepatic encephalopathy due to a paraumbilical shunt; embolization was successfully performed by means of a percutaneous transparaumbilical venous approach.…”

Successful embolization of ileal conduit stomal varices with N-butyl cyanoacrylate via a recanalized paraumbilical vein

“…As the patient was worried about pain from the transhepatic approach, we selected paraumbilical vein access instead of transhepatic access because we considered it to be less painful. The usefulness and safety of paraumbilical vein access has been reported [6] , [7] , and this approach has been applied to embolization procedures [7] , [8] . We successfully punctured the paraumbilical vein with a diameter of approximately 2 mm under real-time ultrasound guidance, although paraumbilical veins with a diameter of less than 3 mm at the puncture site have been associated with failed catheterization [6] .…”

“…NBCA is a liquid embolic material and may be more effective than coils in obliterating ileal conduit stomal varices that are complex in structure [9] . In addition, NBCA occludes blood vessels and varices regardless of coagulation status and is advantageous for patients with coagulopathy [8] .…”

Combination of transjugular intrahepatic portosystemic shunt and antegrade through-the-TIPS coil embolization for bleeding mixed-type ectopic ileal varices

“…To date, few case reports and case series on management and treatment of bleeding ileal varices have been published, with interventional radiology playing a pivotal role. Treatment of ileal varices was achieved by transjugular intrahepatic portosystemic shunt (TIPS), balloon-occluded retrograde transvenous obliteration (BRTO), percutaneous transhepatic procedure, or antegrade embolization of ileal varices via recanalized paraumbilical veins [ 3 – 7 ]. We report a case of bleeding ectopic ileal varices in a patient with severe portal hypertension and thrombosis of the recanalized paraumbilical vein successfully treated by the combination of TIPS placement and antegrade through-the-TIPS coil embolization.…”