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

Ibrahim Mohammad Nadeem; Zain Badar; Victoria Giglio; Steffan Frosi Stella; George Markose; Sabarinath Nair

doi:10.1177/20584601221112618

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

Acta Radiol Open. 2022 Jul 5;11(7):20584601221112618. doi: 10.1177/20584601221112618. eCollection 2022 Jul.

Authors

Ibrahim Mohammad Nadeem¹, Zain Badar², Victoria Giglio³, Steffan Frosi Stella⁴, George Markose⁴, Sabarinath Nair⁴

Affiliations

¹ Department of Radiology, McMaster University, Hamilton, ON, Canada.
² Division of Vascular and Interventional Radiology, Department of Medical Imaging, University Health Network/University of Toronto, Toronto, ON, Canada.
³ Department of Radiology, Juravinski Hospital, McMaster University, Hamilton, ON, Canada.
⁴ Department of Surgery, McMaster University, Hamilton, ON, Canada.

Abstract

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.

Keywords: Balloon-occluded antegrade transvenous obliteration; parastomal varices; percutaneous transhepatic obliteration; portal hypertension; small bowel varices.