Rika Yoshimatsu

Background: Balloon-occluded retrograde transvenous obliteration (B-RTO) has become known as an effective treatment for gastric varices with a gastrorenal shunt. However, the appropriate duration to maintain inflation of the catheter balloon for sufficient thrombosis has been unknown. Purpose: To evaluate retrospectively the factors related to the development of thrombus in gastric varices by evaluating the necessity of the addition of a sclerosing agent on the second day in overnight B-RTO. Material and Methods: Sixty-five patients who underwent B-RTO for gastric varices with a gastrorenal shunt were studied. The B-RTO catheter was retained overnight in all patients. Incidence of and factors influencing the necessity of additional injections of a sclerosing agent on the second day were investigated. Results: In all 65 patients (100%), B-RTO was technically successful and in 61 patients (93.8%) complete thrombosis of the gastric varices was achieved. In 46 of the 65 patients (70.8%), the sclerosing agent was added on the second day. Higher Child-Pugh score, in particular, lower serum albumin level, and higher prothrombin time-international normalized ratio (PT-INR) were significantly associated with the need for the addition of the sclerosing agent on the second day. Optimal cut-off values for the serum albumin level and PT-INR were 3.6 g/dL and 1.13, respectively. Conclusion: Liver function might influence the development of thrombosis of gastric varices in B-RTO. Serum albumin and PT-INR levels would provide information for deciding on the duration of retention of the B-RTO catheter to obtain sufficient therapeutic effectiveness.

We experienced a case with a gastric varix that did not have a catheterizable main drainage vein and had multiple afferent veins. For this case we successfully performed percutaneous transhepatic sclerotherapy using the following procedure. After the drainage vein was embolized by metallic coils and n-butyl cyanoacrylate from a microcatheter that was advanced through the gastric varix, 5% ethanolamine oleate-iopamidol was infused into the gastric varix from one main afferent vein under balloon occlusion.

Purpose To evaluate the correlation between computed tomography (CT) findings after therapeutic lymphangiography for lymphatic leakage and the clinical course of lymphatic leakage. Materials and methods Therapeutic lymphangiography for lymphatic leakage was performed in 14 patients. In all patients, CT was performed 0.5–26 h (mean 6.9 h) after lymphangiography and results were retrospectively evaluated. Results In 8 of the 14 patients (57 %), lymphatic leakage stopped after lymphangiography. Lymphatic leakage was detected on CT in 9 of the 14 patients (64 %) and had either a nodular (n = 4) or beaded appearance (n = 5). The amount of drainage had decreased the day after lymphangiography, and leakage finally stopped in all 4 patients in whom the leakage had a nodular appearance. However, leakage did not stop in 3 of the 5 patients having leakage with a beaded appearance. Conclusion A nodular appearance of leakage might predict success of therapeutic lymphangiography.