Korean J Radiol.  2012 Jun;13(3):324-331. 10.3348/kjr.2012.13.3.324.

Development of Thrombus in a Systemic Vein after Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varices

• Yoshimatsu R
• Yamagami T
• Tanaka O
• Miura H
• Okuda K
• Hashiba M
• Nishimura

• KMID: 1372852
• DOI: http://doi.org/10.3348/kjr.2012.13.3.324

Abstract

OBJECTIVE
To retrospectively evaluate the frequency and risk factors for developing thrombus in a systemic vein such as the infrarenal inferior vena cava or the iliac vein, in which a balloon-occluded retrograde transvenous obliteration (B-RTO) catheter was indwelled.
MATERIALS AND METHODS
Forty-nine patients who underwent B-RTO for gastric varices were included in this study. The B-RTO procedure was performed from the right femoral vein, and the B-RTO catheter was retained overnight in all patients. Pre- and post-procedural CT scans were retrospectively compared in order to evaluate the development of thrombus in the systemic vein in which the catheter was indwelled. Additionally, several variables were analyzed to assess risk factors for thrombus in a systemic vein.
RESULTS
In all 49 patients (100%), B-RTO was technically successful, and in 46 patients (94%), complete thrombosis of the gastric varices was achieved. In 6 patients (12%), thrombus developed in the infrarenal inferior vena cava or the right common-external iliac vein. All thrombi lay longitudinally on the right side of the inferior vena cava or the right iliac vein. One of the aforementioned 6 patients required anticoagulation therapy. No symptoms suggestive of pulmonary embolism were observed. Prothrombin time-international normalized ratio and the addition of 5% ethanolamine oleate iopamidol, on the second day, were related to the development of thrombus.
CONCLUSION
Development of a thrombus in a systemic vein such as the inferior vena cava or iliac vein, caused by indwelling of the B-RTO catheter, is relatively frequent. Physicians should be aware of the possibility of pulmonary embolism due to iliocaval thrombosis.

Keyword

Interventional radiology; Balloon-occluded retrograde transvenous obliteration; Gastric varices; Complications

MeSH Terms

Adult
Aged
Aged, 80 and over
Balloon Occlusion/*methods
Catheters, Indwelling/*adverse effects
Esophageal and Gastric Varices/etiology/*therapy
Female
Femoral Vein
Humans
International Normalized Ratio
Iopamidol/administration & dosage
Male
Middle Aged
Oleic Acids/administration & dosage
Prothrombin Time
Retrospective Studies
Risk Factors
Statistics, Nonparametric
Tomography, X-Ray Computed
Treatment Outcome
Venous Thrombosis/drug therapy/*etiology/*radiography

Figure

• 

  Fig. 1 58-year-old man with gastric varices. Balloon-occluded retrograde transvenous obliteration (B-RTO) was performed by injecting 20 mL 5% ethanolamine oleate iopamidol (Patient no. 6 in Table 1). A. Roentgenogram obtained after injection of sclerotic agent showed complete filling by sclerotic agent in gastric varix (arrowhead), curved catheter sheath-introducer inserted to left renal vein (large arrow), and balloon catheter wedged into gastrorenal shunt (small arrow). B. Roentgenogram obtained day following injection of sclerotic agent showed complete thrombosis of varices (arrowhead). Note that sheath-introducer in inferior vena cava is seen (arrows). C-E. Enhanced CT obtained 6 days after B-RTO shows thrombus in infrarenal inferior vena cava and right common-external iliac vein lying longitudinally on right side of vessel wall (arrows).

• 

  Fig. 2 45-year-old woman with gastric varices. Balloon-occluded retrograde transvenous obliteration (B-RTO) was performed by injecting 15 mL 5% ethanolamine oleate iopamidol (Patient no. 5 in Table 1). A, B. Enhanced CT obtained 6 days after B-RTO shows thrombus in infrarenal inferior vena cava lying longitudinally on right anterior side of vessel wall (arrows).

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