Embolization of parastomal and small bowel ectopic varices utilizing a transhepatic antegrade approach: A case series

• Published in: Acta radiologica open Vol. 11; no. 7; pp. 205846012211126 - 20584601221112618
• Main Authors: Nadeem, Ibrahim Mohammad, Badar, Zain, Giglio, Victoria, Stella, Steffan Frosi, Markose, George, Nair, Sabarinath
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.07.2022; Sage Publications Ltd
• Subjects: Bleeding; Complications; Electronic health records; Electronic medical records; Embolization; Hernias; Original; Ostomy; Patients; Postoperative; Small intestine; Vascular surgery; portal hypertension; percutaneous transhepatic obliteration; Balloon-occluded antegrade transvenous obliteration; parastomal varices; small bowel varices
• ISSN: 2058-4601; 2058-4601
• DOI: 10.1177/20584601221112618

Background The ideal approach to managing parastomal and small bowel ectopic varices (EVs) is yet to be established. Purpose To evaluate outcomes following percutaneous antegrade transhepatic venous obliteration (PATVO) in patients presenting with bleeding from parastomal or small bowel EVs. Material and Methods A case series of 12 patients presenting with active or recurrent bleeding from parastomal or small bowel EVs who underwent 17 PATVO interventions at our tertiary care institution was performed. Data extraction from electronic medical records included baseline characteristics and procedural details. Endpoints included technical success, early clinical success, and re-bleeding. Results Technical success was 100% (n = 17), and early clinical success was 82.3% (n = 14). No patient experienced any intra- or post-operative complications. Rebleed rates after initial PATVO in patients who achieved early clinical success was as follows: 3-month, 0% (n = 0); 6-month, 20% (n = 2); 12-month, 20% (n = 2). Rebleed rates after all PATVO procedures (including patients undergoing repeat procedures) that achieved early clinical success were as follows: 3-month, 0% (n = 0); 6-month, 14% (n = 2; 12-month, 14% (n = 2). All patients with re-bleeding required reintervention with either PATVO, transjugular intrahepatic portosystemic shunt (TIPS) or both. Conclusion PATVO can be safely performed to treat bleeding from parastomal and small bowel EVs. In patients who present with recurrent bleeding despite PATVO, TIPS with/without embolization of bleeding varices remains a valid option as described by the literature.