Combined transmesenteric and transhepatic recanalization of chronic portal and mesenteric vein occlusion to treat bleeding duodenal varices

Saher S Sabri; Stephen H Caldwell; Sean C Kumer; Timothy M Schmitt; Daniel G Maluf; John F Angle; Wael E Saad

doi:10.1016/j.jvir.2013.11.021

Combined transmesenteric and transhepatic recanalization of chronic portal and mesenteric vein occlusion to treat bleeding duodenal varices

J Vasc Interv Radiol. 2014 Aug;25(8):1295-9. doi: 10.1016/j.jvir.2013.11.021.

Authors

Saher S Sabri¹, Stephen H Caldwell², Sean C Kumer³, Timothy M Schmitt³, Daniel G Maluf⁴, John F Angle⁵, Wael E Saad⁵

Affiliations

¹ Division of Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Box 800170, 1215 Lee Street, Charlottesville, VA 22908. Electronic address: [email protected].
² Division of Gastroenterology, Department of Medicine, University of Virginia Health System, Box 800170, 1215 Lee Street, Charlottesville, VA 22908.
³ Department of Transplantation Surgery, University of Kansas Hospital, Kansas City, Kansas.
⁴ Department of Surgery, University of Virginia Health System, Box 800170, 1215 Lee Street, Charlottesville, VA 22908.
⁵ Division of Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Box 800170, 1215 Lee Street, Charlottesville, VA 22908.

PMID: 25085062
DOI: 10.1016/j.jvir.2013.11.021

Abstract

Two patients presented with bleeding duodenal varices secondary to mesenteric and portal vein chronic occlusion. After a failed transhepatic recanalization, a combined transmesenteric and transhepatic approach was used to recanalize the chronic portal and mesenteric venous obstruction. The occluded segment was treated with transmesenteric stent placement in one patient and stent placement and coil embolization of varices in the second patient. Follow-up imaging and endoscopy showed decompression of the duodenal varices in both patients and absence of further bleeding episodes.

Publication types

Case Reports

MeSH terms

Adult
Angiography, Digital Subtraction
Chronic Disease
Cone-Beam Computed Tomography
Duodenum / blood supply*
Embolization, Therapeutic* / instrumentation
Female
Gastrointestinal Hemorrhage / diagnosis
Gastrointestinal Hemorrhage / etiology
Gastrointestinal Hemorrhage / therapy*
Humans
Male
Mesenteric Vascular Occlusion / complications
Mesenteric Vascular Occlusion / diagnosis
Mesenteric Vascular Occlusion / physiopathology
Mesenteric Vascular Occlusion / therapy*
Mesenteric Veins* / diagnostic imaging
Mesenteric Veins* / physiopathology
Phlebography / methods
Portal Vein* / diagnostic imaging
Portal Vein* / physiopathology
Stents
Treatment Outcome
Varicose Veins / diagnosis
Varicose Veins / etiology
Varicose Veins / therapy*
Vascular Patency