Interventional Radiology for Bleeding Ectopic Varices: Individualized Approach Based on Vascular Anatomy

作者：Hyo‐Cheol Kim, Shiro Miyayama, Edward Lee, David Yurui Lim, Jin Wook Chung, Hwan Jun Jae, Jin Woo Choi · 发表于：Radiographics · 年份：2024 · DOI：10.1148/rg.230140 · 被引用次数：10 · 研究领域：Liver Disease and Transplantation、Vascular anomalies and interventions、Liver Disease Diagnosis and Treatment

Ectopic varices are rare but potentially life-threatening conditions usually resulting from a combination of global portal hypertension and local occlusive components. As imaging, innovative devices, and interventional radiologic techniques evolve and are more widely adopted, interventional radiology is becoming essential in the management of ectopic varices. The interventional radiologist starts by diagnosing the underlying causes of portal hypertension and evaluating the afferent and efferent veins of ectopic varices with CT. If decompensated portal hypertension is causing ectopic varices, placement of a transjugular intrahepatic portosystemic shunt is considered the first-line treatment, although this treatment alone may not be effective in managing ectopic variceal bleeding because it may not sufficiently resolve focal mesenteric venous obstruction causing ectopic varices. Therefore, additional variceal embolization should be considered after placement of a transjugular intrahepatic portosystemic shunt. Retrograde transvenous obliteration can serve as a definitive treatment when the efferent vein connected to the systemic vein is accessible. Antegrade transvenous obliteration is a vital component of interventional radiologic management of ectopic varices because ectopic varices often exhibit complex anatomy and commonly lack catheterizable portosystemic shunts. Superficial veins of the portal venous system such as recanalized umbilical veins may provide safe access for an...