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Masuda S, Tsukiyama T, Makazu M, Jinushi R, Koizumi K, Nishino T, Shionoya K, Kimura K, Sumida C, Kubota J, Ichita C, Sasaki A, Kobayashi M, Kako M, Uojima H. A case of unsuccessful obliteration of percutaneous transhepatic gastric varices using the IMPEDE embolization plug. Clin Case Rep 2023; 11:e07323. [PMID: 37180327 PMCID: PMC10167619 DOI: 10.1002/ccr3.7323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/31/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023] Open
Abstract
Key Clinical Message Embolization with IMPEDE embolization plug cannot be confirmed on site. Therefore, we propose that the diameter of the device selected be up to 50% larger than the vein diameter to prevent embolization failure and recanalization. Abstract Balloon-occluded retrograde transvenous obliteration and percutaneous transhepatic obliteration (PTO) are performed for treating sporadic gastric varices. IMPEDE embolization plug has been recently developed for these procedures; however, no studies have reported its use. This is the first report on its use in PTO of gastric varices.
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Affiliation(s)
- Sakue Masuda
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Toshitaka Tsukiyama
- Department of Interventional Radiology CenterShonan Kamakura General HospitalKamakuraJapan
| | - Makomo Makazu
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Ryuhei Jinushi
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Kazuya Koizumi
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Takashi Nishino
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Kento Shionoya
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Karen Kimura
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Chihiro Sumida
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Jun Kubota
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Chikamasa Ichita
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Akiko Sasaki
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Masahiro Kobayashi
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Makoto Kako
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraJapan
| | - Haruki Uojima
- Department of Gastroenterology, Internal MedicineKitasato University School of MedicineSagamiharaJapan
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Osaragi K, Matsumoto T, Yoshimatsu R, Ito A, Nagata J, Kojima S, Hasebe T, Suzuki T, Yamagami T. Percutaneous Transhepatic Obliteration for Treating Stomal Variceal Bleeding Using a Microballoon Catheter with Systemic Drainage Vein Compression. Interv Radiol (Higashimatsuyama) 2022; 7:100-103. [PMID: 36483666 PMCID: PMC9719817 DOI: 10.22575/interventionalradiology.2021-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/12/2022] [Indexed: 06/17/2023]
Abstract
We report a case of successful treatment of stomal variceal bleeding with percutaneous transhepatic obliteration using a microballoon catheter concomitantly with drainage vein compression. A 72-year-old man with alcoholic cirrhosis was admitted to our hospital due to repeated hemorrhage of stomal varices. Percutaneous transhepatic obliteration was then selected for treatment because computed tomography revealed the stomal varices being fed by only two branches of the superior and inferior mesenteric veins. During microballoon inflation, 5% ethanolamine oleate with iopamidol was injected into each branch, and the systemic drainage veins were compressed by the gauze from the body surface near the stoma. No rebleeding from the stomal varices has been observed 14 months after the procedure.
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Affiliation(s)
- Kensuke Osaragi
- Department of Diagnostic and Interventional Radiology, Kochi University, Kochi Medical School Kohasu, Japan
| | - Tomohiro Matsumoto
- Department of Diagnostic and Interventional Radiology, Kochi University, Kochi Medical School Kohasu, Japan
| | - Rika Yoshimatsu
- Department of Diagnostic and Interventional Radiology, Kochi University, Kochi Medical School Kohasu, Japan
| | - Ayano Ito
- Department of Gastroenterology, Tokai University Hachioji Hospital, Japan
| | - Junko Nagata
- Department of Gastroenterology, Tokai University Hachioji Hospital, Japan
| | - Seiichiro Kojima
- Department of Gastroenterology, Tokai University Hachioji Hospital, Japan
| | - Terumitsu Hasebe
- Department of Radiology, Tokai University Hachioji Hospital, Japan
| | - Takayoshi Suzuki
- Department of Gastroenterology, Tokai University Hachioji Hospital, Japan
| | - Takuji Yamagami
- Department of Diagnostic and Interventional Radiology, Kochi University, Kochi Medical School Kohasu, Japan
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Kawai T, Yata S, Matsumoto K, Miyoshi K, Noguchi N, Fujii S. A Case of Esophagojejunal Variceal Rupture after Total Gastrectomy and Esophagojejunostomy Successfully Treated with Percutaneous Transhepatic Obliteration under Dual-balloon Occlusion of Feeding and Draining Veins. Interv Radiol (Higashimatsuyama) 2022; 7:114-118. [PMID: 36483665 PMCID: PMC9719818 DOI: 10.22575/interventionalradiology.2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/12/2022] [Indexed: 06/17/2023]
Abstract
We present the case of a man in his 60s with bleeding esophagojejunal varices occurring after gastrectomy for gastric carcinoma. Percutaneous transhepatic portography depicted the esophagojejunal varices originated from the jejunal vein and drained into the azygos vein. A 5-French occlusion balloon catheter was wedged into the jejunal vein and a 3-French occlusion balloon catheter into one drainage channel of the esophagojejunal varices via the azygos vein. Selective antegrade jejunal venography under dual-balloon occlusion revealed entire esophagojejunal varices with good stagnated and well-opacified contrast medium. Subsequently, 12 mL of 5% ethanolamine oleate-contrast medium mixture was slowly injected into the esophagojejunal varices. He was discharged without complications one week after the procedure, and abdominal computed tomography demonstrated the disappearance of the esophagojejunal varices six months after the procedure.
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Affiliation(s)
- Tsuyoshi Kawai
- Department of Radiology, Tottori Prefectural Kousei Hospital, Japan
| | - Shinsaku Yata
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Japan
| | | | - Kenichi Miyoshi
- Department of Gastroenterology, Tottori Prefectural Kousei Hospital, Japan
| | - Naoya Noguchi
- Department of Gastroenterology, Tottori Prefectural Kousei Hospital, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Japan
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Toyodome A, Tamai T, Sasaki F, Hashiguchi M, Taniyama O, Ijuin S, Sakae H, Tabu K, Oda K, Kumagai K, Mawatari S, Ido A. Successful Percutaneous Transhepatic Obliteration Plus Sengstaken-Blakemore Tube Combination Therapy for Recurrent Gastroesophageal Variceal Bleeding: A Case Report. Intern Med 2022. [PMID: 36328577 DOI: 10.2169/internalmedicine.0666-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We treated a case of gastroesophageal varices due to decompensated liver cirrhosis associated with Wilson's disease. The varicose veins penetrated the paraesophageal vein. We performed endoscopic variceal ligation (EVL) on the perforating vein and endoscopic injection sclerotherapy (EIS) distally. However, 5 days after treatment, the patient vomited blood. Esophagogastroduodenoscopy showed bleeding from the ulcer after EVL at the perforating vein. We performed EVL and stopped the bleeding. However, the next day, she vomited blood again and developed hemorrhagic shock. We were able to achieve hemostasis and save the patient's life with combination therapy consisting of percutaneous transhepatic obliteration and Sengstaken-Blakemore tube placement.
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Affiliation(s)
- Ai Toyodome
- Department of Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Tsutomu Tamai
- Department of Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
- Department of Gastroenterology, Kagoshima City Hospital, Japan
| | - Fumisato Sasaki
- Department of Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | | | - Ohki Taniyama
- Department of Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Sho Ijuin
- Department of Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Haruka Sakae
- Department of Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Kazuaki Tabu
- Department of Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Kohei Oda
- Department of Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Kotaro Kumagai
- Department of Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Seiichi Mawatari
- Department of Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Akio Ido
- Department of Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
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Ishikawa T. Efficacy of interventional radiology in the management of portal hypertension: A narrative review. Medicine (Baltimore) 2022; 101:e30018. [PMID: 35984127 PMCID: PMC9387995 DOI: 10.1097/md.0000000000030018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Portal hypertension is associated with numerous adverse effects, including the formation of gastroesophageal varices and a portal vein general circulation shunt. Portal hypertension can lead to portal blood flow into the liver and a subsequent reduction in liver function. Clinical interventions can be hampered by a concurrent reduction in circulating platelets associated with increased splenic activity. Pharmaceutical interventions for the treatment of complications associated with portal hypertension have achieved various degrees of success. However, an effective therapeutic strategy for portal hypertension has not yet been established. A literature search was performed using "PubMed." Database between 1966 and January 2021 using the following keywords: portal hypertension, interventional radiology, balloon-occluded retrograde transvenous obliteration, transjugular retrograde obliteration of gastric varices, percutaneous transhepatic obliteration, partial splenic embolization, and transjugular intrahepatic portosystemic shunting. In this narrative review, we summarize the application of interventional radiology in patients with portal hypertension, including techniques for embolization of collateral veins and portal pressure reduction. These up-to-date interventional radiology techniques can be used to treat portal hypertension. The data that support the findings of this study are available from the corresponding author, upon reasonable request.
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Affiliation(s)
- Toru Ishikawa
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
- *Correspondence: Toru Ishikawa, Department of Gastroenterology, Saiseikai Niigata Hospital, Teraji 280-7, Niigata 950-1104, Japan (e-mail: )
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Ierardi AM, Carnevale A, Tosetti G, D'Amico M, Giganti M, Mura VL, Bonelli C, Renzulli M, Lampertico P, Primignani M, Carrafiello G. Combined approach for embolization of otherwise unmanageable gastric varices. Ann Gastroenterol 2021; 34:510-515. [PMID: 34276189 PMCID: PMC8276367 DOI: 10.20524/aog.2021.0616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/28/2021] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to determine the feasibility, safety and effectiveness of
combined percutaneous transhepatic obliteration (PTO) and balloon-occluded
retrograde transvenous obliteration (BRTO) therapy for the treatment of
patients with high-risk bleeding gastric varices. Methods Ten patients were retrospectively reviewed. All the patients presented
gastric varices, according to the Sarin classification, at high risk of
bleeding, and not otherwise manageable. Patients with portal vein thrombosis
were excluded. All patients were treated with a combination of PTO and BRTO.
In all cases the gastric varices were embolized with glue, combined with
coils or not, with an occlusion balloon inflated into the shunt. In 7 cases,
embolization was immediate; in the remaining 3 the balloon remained inflated
for 4 h and in 2 of them embolization of the shunt was required. Technical
success was defined as complete obliteration of the gastric varices observed
during a contrast-enhanced computed tomography study and endoscopy within 1
month following treatment. Clinical success was defined as absence of
bleeding of gastric varices during the follow-up period. Major and minor
complications during the follow up were recorded. Results Twelve sessions of combined PTO and BRTO procedures were performed in 10
patients; in 2 patients a new combined treatment was required during the
follow up. Technical and clinical success was 100%. Neither major nor
minor procedure-related complications were observed. Conclusion Combined PTO and BRTO therapy is safe and effective for the treatment of
gastric varices that cannot be managed otherwise.
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Affiliation(s)
- Anna Maria Ierardi
- Radiology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan (Anna Maria Ierardi, Gianpaolo Carrafiello)
| | - Aldo Carnevale
- Radiology Department, University Radiology Unit, Sant'Anna University Hospital, Ferrara (Aldo Carnevale)
| | - Giulia Tosetti
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan (Giulia Tosetti, Massimo Primignani)
| | - Mario D'Amico
- UOC Radiodiagnostica; Ospedali Riuniti Villa Sofia-Cervello, Palermo (Mario D'Amico)
| | - Melchiore Giganti
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara (Melchiore Giganti)
| | - Vincenzo La Mura
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, U.O.C. Medicina Generale Emostasi e Trombosi, University of Milan (Vincenzo La Mura)
| | - Cristian Bonelli
- Healthcare Professionals Department, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan (Cristian Bonelli)
| | - Matteo Renzulli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna (Matteo Renzulli)
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan (Giulia Tosetti, Massimo Primignani).,Department of Pathophysiology and Transplantation, University of Milan, Milano, Lombardia (Pietro Lampertico)
| | - Massimo Primignani
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan (Giulia Tosetti, Massimo Primignani)
| | - Gianpaolo Carrafiello
- Radiology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan (Anna Maria Ierardi, Gianpaolo Carrafiello).,Department of Health Sciences, Università degli Studi di Milano, Milan (Gianpaolo Carrafiello), Italy
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Ishikawa T, Imai M, Ko M, Sato H, Nozawa Y, Sano T, Iwanaga A, Seki K, Honma T, Yoshida T. Percutaneous transhepatic obliteration and percutaneous transhepatic sclerotherapy for intractable hepatic encephalopathy and gastric varices improves the hepatic function reserve. Biomed Rep 2016; 6:99-102. [PMID: 28123716 DOI: 10.3892/br.2016.811] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/27/2016] [Indexed: 02/06/2023] Open
Abstract
Percutaneous transhepatic obliteration (PTO) and percutaneous transhepatic sclerotherapy (PTS) are widely performed as an emergency measure in cases of variceal hemorrhage and intractable hepatic encephalopathy. The PTO/PTS technique is capable of directly blocking the blood supply in cases in which balloon-occluded retrograde transvenous obliteration (B-RTO) is not effective, or in cases with complicated collateral flow. Although PTO/PTS is not currently the first choice due to the invasiveness of transhepatic puncture, this procedure can modify the blood flow in an antegrade manner. The present study examined the changes in hepatic function reserve following PTO/PTS for intractable hepatic encephalopathy and/or gastric varices. In total, the study included 37 patients (mean age, 61.75±12.77 years; age range, 32-88 years; male to female ratio, 23:14) with a variety of gastrorenal shunts, or B-RTO-intractable hepatic encephalopathy and gastric varices without gastrorenal shunts. The patients underwent PTO/PTS by embolizing a microcoil or injection of a sclerosing agent (5% ethanolamine oleate iopamidol). Alterations in hepatic function reserve prior to and following the procedure were compared. The patients were treated for hepatic encephalopathy in 11 patients, gastric varices in 19 patients, and both conditions in 7 patients. The results indicated that the blood ammonia level improved from 135.76±75.23 mg/dl to 88.00±42.16 and 61.81±33.75 mg/dl at 3 and 6 months after therapy, respectively. In addition, the Child-Pugh score improved from 8.48±2.01 prior to therapy to 7.70±1.84 and 7.22±2.01 at 3 and 6 months after the procedure, respectively. Although there was a concern that PTO/PTS may cause complications due to an increase in portal venous pressure (PVP) arising from shunt occlusion, no severe complications were observed. In conclusion, for patients with various gastrorenal shunts or those with B-RTO-intractable hepatic encephalopathy and gastric varices without gastrorenal shunts, PTO/PTS can improve the antegrade blood flow to the liver, as demonstrated by improvement in the hepatic function reserve.
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Affiliation(s)
- Toru Ishikawa
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
| | - Michitaka Imai
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
| | - Masayoshi Ko
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
| | - Hiroki Sato
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
| | - Yujiro Nozawa
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
| | - Tomoe Sano
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
| | - Akito Iwanaga
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
| | - Keiichi Seki
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
| | - Terasu Honma
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
| | - Toshiaki Yoshida
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
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Yoshimatsu R, Yamagami T, Miura H, Okuda K. Percutaneous transhepatic sclerotherapy with embolization of the drainage vein for a gastric varix. Acta Radiol Short Rep 2014; 3:2047981614530285. [PMID: 25298873 PMCID: PMC4184380 DOI: 10.1177/2047981614530285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 03/12/2014] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Rika Yoshimatsu
- Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan ; Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuji Yamagami
- Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan ; Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroshi Miura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kotaro Okuda
- Department of Internal Medicine, Kyoto Kujo Hospital, Kyoto, Japan
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