Modified percutaneous transhepatic variceal embolization with 2-octylcyanoacrylate for bleeding gastric varices: long-term follow-up outcomes.

Abstract

OBJECTIVE:

The objective of our study was to evaluate the long-term efficacy and safety of a modified percutaneous transhepatic variceal embolization procedure with 2-octylcyanoacrylate (2-OCA) in the treatment of gastric variceal bleeding.

MATERIALS AND METHODS:

From January 2003 to December 2008, 71 patients with a history of gastric variceal bleeding underwent modified percutaneous transhepatic variceal embolization with 2-OCA in our hospital: 12 patients with acute gastric variceal bleeding underwent emergency obliteration and the remaining 59 patients with recent variceal bleeding underwent modified percutaneous transhepatic variceal embolization as a secondary prophylaxis. The initial hemostasis rate, rebleeding rate, survival rate, and complications were evaluated.

RESULTS:

Complete obliteration--that is, all the gastric varices and their feeding veins were obliterated--was achieved after the percutaneous transhepatic variceal embolization procedure in 67 patients (94.4%). Acute variceal bleeding was arrested after the procedure in all 12 patients (100%). The mean follow-up period was 24.2 ± 12.4 (SD) months (range, 6-62 months). During the follow-up period, the cumulative probability of remaining free of gastric variceal rebleeding in patients with complete obliteration was 100%, 88.2%, and 88.2% at 1, 3, and 5 years after the procedure, respectively. Follow-up CT revealed that the modified percutaneous transhepatic variceal embolization procedure with 2-OCA can achieve long-lasting obliteration in the entire varices and in all the feeding veins. The cumulative survival rates at 1, 3, and 5 years after the procedure were 96.9%, 68.9%, and 53.7%. No severe complications occurred after the procedure.

CONCLUSION:

The modified percutaneous transhepatic variceal embolization with 2-OCA is considered to be an effective and safe method for the extensive and permanent obliteration of both gastric varices and their feeding veins.

• Authors: Xiangguo Tian, Qizhi Wang, Chunqing Zhang, Fuli Liu, Yi Cui, Feng Liu, Jiyong Liu
• Journal: AJR. American journal of roentgenology (AJR Am J Roentgenol) Vol. 197 Issue 2 Pg. 502-9 (Aug 2011) ISSN: 1546-3141 [Electronic] United States
• PMID: 21785101 (Publication Type: Journal Article)

Chemical References

• Cyanoacrylates
• Tissue Adhesives
• octyl 2-cyanoacrylate

Topics

• Adult
• Aged
• Angioplasty, Balloon
• Cyanoacrylates (therapeutic use)
• Embolization, Therapeutic (methods)
• Endoscopy, Gastrointestinal
• Esophageal and Gastric Varices (etiology, therapy)
• Female
• Follow-Up Studies
• Gastrointestinal Hemorrhage (etiology, therapy)
• Hepatitis B (complications)
• Humans
• Liver Cirrhosis (complications, diagnostic imaging)
• Male
• Middle Aged
• Portography
• Proportional Hazards Models
• Recurrence
• Survival Rate
• Tissue Adhesives (therapeutic use)
• Tomography, X-Ray Computed
• Treatment Outcome