Carbon Dioxide (CO2 ) vs Iodinated Contrast Digital Subtraction Angiography during Balloon-occluded Retrograde Transvenous Obliteration (BRTO) Using Foam Sclerosant for Gastric Varices

• Published in: Journal of vascular and interventional radiology Vol. 23; no. 11; pp. 1453 - 1459.e1
• Main Authors: Koizumi, Jun, MD, PhD, Hashimoto, Takeshi, MD, Myojin, Kazunori, MD, PhD, Itou, Chihiro, MD, Hara, Takuya, MD, Sekiguchi, Tatsuya, MD, Ichikawa, Tamaki, MD, PhD, Imai, Yutaka, MD, Kagawa, Tatehiro, MD, PhD, Nagata, Naruhiko, MD, PhD, Watanabe, Norihito, MD, PhD, Mine, Tetsuya, MD, PhD, Nishibe, Toshiya, MD, PhD, Saguchi, Toru, MD, PhD, Janne d'Othée, Bertrand
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2012
• Subjects: Aged; Angiography, Digital Subtraction; Balloon Occlusion; Carbon Dioxide; Collateral Circulation; Contrast Media; Embolization, Therapeutic; Esophageal and Gastric Varices - diagnostic imaging; Esophageal and Gastric Varices - physiopathology; Esophageal and Gastric Varices - therapy; Female; Humans; Iodine; Male; Middle Aged; Phlebography; Predictive Value of Tests; Radiography, Interventional - methods; Radiology; Sclerosing Solutions - therapeutic use; Sclerotherapy; Splanchnic Circulation; Time Factors; Treatment Outcome; balloon-occluded retrograde transvenous venography; CO 2; carbon dioxide; DSA; BRTO; balloon-occluded retrograde transvenous obliteration; digital subtraction angiography; gastric varices; BRTV; GV; CO2
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2012.08.004

Abstract Purpose To compare the visualization of the target gastric varices (GV) on balloon-occluded retrograde transvenous venography (BRTV) using iodinated contrast material vs carbon dioxide (CO2) in preparation for subsequent balloon-occluded retrograde transvenous obliteration (BRTO) using foam sclerotherapy. Materials and Methods In 16 consecutive patients with nonruptured GV, BRTV was performed first using iodinated contrast material and then with CO2 . BRTV was repeated whenever there were changes in the catheter or patient position or when coil embolization of collaterals was needed. Each visualization grade of GV (grade 1=GV only; grade 2=GV >collaterals; 3=GV<collaterals; grades 4–5=collaterals only) was determined by two observers in consensus. During foam BRTO, the GV visualization grade was recorded again and confirmed by C-arm computed tomography (CT). Results In 38 pairs of BRTV, GV grades were significantly ( P< .0001) lower (ie, favoring BRTO) on CO2 BRTV (mean±standard deviation, 1.8±0.8) than on iodine BRTV (3.4±0.8). GV grades on foam BRTO (1.4±0.7) were similar to the grades obtained on the most recent CO2 BRTV (1.3±0.5) but were significantly smaller ( P< .0001) than on iodinated BRTV (3.1±0.9). GV were opacified by foam on initial C-arm CT in 14 patients (87.5%), and complete thrombosis of GV was obtained without any complication in all 16 patients (100%). CO2 reached the GV even when iodinated contrast material could not (grade 4) in seven of our 16 patients (43.8%), leading to successful BRTO. Conclusions CO2 BRTV visualized GV better than did iodine BRTV and changed the management of more than 40% of patients by enabling successful foam BRTO in patients in which conventional liquid BRTO could not be performed.