111 - Transjugular Antegrade Transvenous Obliteration, With and Without Portal Decompression, for Management of Rectal Variceal Hemorrhage

Monday, March 31, 2025

12:10 PM – 1:10 PM CT

Location: Music City Center, Expo Poster Area

Author/Co-author(s)

GL

Gabe Li, MD

Integrated IR Resident
University of Washington, United States
Jeffrey Forris Beecham Chick, MD, MPH

Professor of Clinical Radiology
Keck School of Medicine of University of Southern California, United States
EM

Eric Monroe, MD (he/him/his)

Professor
University of Wisconsin, United States

Poster Presenter(s)

MA

Matthew Abad-Santos, MD

Assistant Professor
University of Washington, United States

Author/Co-author(s)

EH

Ethan Hua, MD, MS

Assistant Professor
University of Washington, United States
DS

David S. Shin, MD

Associate Professor
University of Southern California, United States

Purpose: To report antegrade transvenous obliteration, with or without concurrent portosystemic shunt creation, for the treatment of hemorrhagic rectal varices.

Materials and Methods: Eight patients, including five (62.5%) females and three (37.5%) males, with mean age of 55.8 ± 13.8 years (range: 30-70 years), underwent transjugular-approach antegrade transvenous obliteration of rectal varices, with or without portosystemic shunt creation. Demographic data, procedural details, technical success of variceal obliteration, clinical success, adverse events, and follow-up outcomes were retrospectively recorded. Clinical success was defined as resolution of rectal hemorrhage.

Results:

Portal venous access was achieved via a transjugular intrahepatic approach in all patients. The inferior mesenteric vein was selected, and foamy sclerosant (1:2:3 mixture by volume of ethiodized oil:sodium tetradecyl sulfate:air) was injected into the rectal varices with antegrade balloon occlusion in seven (87.5%) and without balloon occlusion in one (12.5%). Five of eight (62.5%) patients underwent concomitant transjugular intrahepatic portosystemic shunt (TIPS) creation (mean diameter 8.4 ± 0.9-mm) immediately following transvenous obliteration. Technical success of variceal obliteration was achieved in all patients. There were no immediate post-procedural adverse events. There were no reported occurrences of rectal ischemia, perforation, or stricture following obliteration. Two (40%) of the patients who underwent concomitant TIPS creation developed hepatic encephalopathy within 30 days of the procedure, which was medically managed. Clinical resolution of hemorrhage was achieved in all patients with no recurrent rectal variceal hemorrhage during mean follow-up of 666 ± 396 days (range: 14-1,224 days).

Conclusion: Transvenous obliteration, with or without concurrent TIPS creation, is feasible with promising results for the management of rectal variceal hemorrhage.