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A 71-year-old woman with duodenal varices. (A) Preoperative contrast-enhanced CT shows varices (arrow) in the second-third portion of the duodenum. (B) Endoscopy shows tortuous and dilated varices in the duodenal wall. (C) Volume-rendering reconstruction of contrast-enhanced CT shows duodenal varices (yellow) that have the fenestrated inferior pancreaticoduodenal vein as an afferent vein (red) that directly drained into the IVC through the mesocaval collateral vessel (green). (D) BRTV using a 5-Fr balloon catheter (arrow) inserted through the IVC showed tortuous and dilated vessels including the varices. (E) A microcatheter inserted through the 5-Fr balloon catheter (arrow) was placed close to the varices, and 9 mL of 5% EOI was injected. (F) Coil embolization (arrowhead) of the efferent vein was performed to prevent outflow of the sclerosant. Abbreviations: BRTV = balloon-occluded retrograde transvenous venography; CT = computed tomography; EOI = <t>ethanolamine</t> oleate iopamidol; IVC = inferior vena cava.
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A 71-year-old woman with duodenal varices. (A) Preoperative contrast-enhanced CT shows varices (arrow) in the second-third portion of the duodenum. (B) Endoscopy shows tortuous and dilated varices in the duodenal wall. (C) Volume-rendering reconstruction of contrast-enhanced CT shows duodenal varices (yellow) that have the fenestrated inferior pancreaticoduodenal vein as an afferent vein (red) that directly drained into the IVC through the mesocaval collateral vessel (green). (D) BRTV using a 5-Fr balloon catheter (arrow) inserted through the IVC showed tortuous and dilated vessels including the varices. (E) A microcatheter inserted through the 5-Fr balloon catheter (arrow) was placed close to the varices, and 9 mL of 5% EOI was injected. (F) Coil embolization (arrowhead) of the efferent vein was performed to prevent outflow of the sclerosant. Abbreviations: BRTV = balloon-occluded retrograde transvenous venography; CT = computed tomography; EOI = <t>ethanolamine</t> oleate iopamidol; IVC = inferior vena cava.
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A 71-year-old woman with duodenal varices. (A) Preoperative contrast-enhanced CT shows varices (arrow) in the second-third portion of the duodenum. (B) Endoscopy shows tortuous and dilated varices in the duodenal wall. (C) Volume-rendering reconstruction of contrast-enhanced CT shows duodenal varices (yellow) that have the fenestrated inferior pancreaticoduodenal vein as an afferent vein (red) that directly drained into the IVC through the mesocaval collateral vessel (green). (D) BRTV using a 5-Fr balloon catheter (arrow) inserted through the IVC showed tortuous and dilated vessels including the varices. (E) A microcatheter inserted through the 5-Fr balloon catheter (arrow) was placed close to the varices, and 9 mL of 5% EOI was injected. (F) Coil embolization (arrowhead) of the efferent vein was performed to prevent outflow of the sclerosant. Abbreviations: BRTV = balloon-occluded retrograde transvenous venography; CT = computed tomography; EOI = <t>ethanolamine</t> oleate iopamidol; IVC = inferior vena cava.
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A 71-year-old woman with duodenal varices. (A) Preoperative contrast-enhanced CT shows varices (arrow) in the second-third portion of the duodenum. (B) Endoscopy shows tortuous and dilated varices in the duodenal wall. (C) Volume-rendering reconstruction of contrast-enhanced CT shows duodenal varices (yellow) that have the fenestrated inferior pancreaticoduodenal vein as an afferent vein (red) that directly drained into the IVC through the mesocaval collateral vessel (green). (D) BRTV using a 5-Fr balloon catheter (arrow) inserted through the IVC showed tortuous and dilated vessels including the varices. (E) A microcatheter inserted through the 5-Fr balloon catheter (arrow) was placed close to the varices, and 9 mL of 5% EOI was injected. (F) Coil embolization (arrowhead) of the efferent vein was performed to prevent outflow of the sclerosant. Abbreviations: BRTV = balloon-occluded retrograde transvenous venography; CT = computed tomography; EOI = <t>ethanolamine</t> oleate iopamidol; IVC = inferior vena cava.
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A 71-year-old woman with duodenal varices. (A) Preoperative contrast-enhanced CT shows varices (arrow) in the second-third portion of the duodenum. (B) Endoscopy shows tortuous and dilated varices in the duodenal wall. (C) Volume-rendering reconstruction of contrast-enhanced CT shows duodenal varices (yellow) that have the fenestrated inferior pancreaticoduodenal vein as an afferent vein (red) that directly drained into the IVC through the mesocaval collateral vessel (green). (D) BRTV using a 5-Fr balloon catheter (arrow) inserted through the IVC showed tortuous and dilated vessels including the varices. (E) A microcatheter inserted through the 5-Fr balloon catheter (arrow) was placed close to the varices, and 9 mL of 5% EOI was injected. (F) Coil embolization (arrowhead) of the efferent vein was performed to prevent outflow of the sclerosant. Abbreviations: BRTV = balloon-occluded retrograde transvenous venography; CT = computed tomography; EOI = <t>ethanolamine</t> oleate iopamidol; IVC = inferior vena cava.
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Image Search Results


A 71-year-old woman with duodenal varices. (A) Preoperative contrast-enhanced CT shows varices (arrow) in the second-third portion of the duodenum. (B) Endoscopy shows tortuous and dilated varices in the duodenal wall. (C) Volume-rendering reconstruction of contrast-enhanced CT shows duodenal varices (yellow) that have the fenestrated inferior pancreaticoduodenal vein as an afferent vein (red) that directly drained into the IVC through the mesocaval collateral vessel (green). (D) BRTV using a 5-Fr balloon catheter (arrow) inserted through the IVC showed tortuous and dilated vessels including the varices. (E) A microcatheter inserted through the 5-Fr balloon catheter (arrow) was placed close to the varices, and 9 mL of 5% EOI was injected. (F) Coil embolization (arrowhead) of the efferent vein was performed to prevent outflow of the sclerosant. Abbreviations: BRTV = balloon-occluded retrograde transvenous venography; CT = computed tomography; EOI = ethanolamine oleate iopamidol; IVC = inferior vena cava.

Journal: The British Journal of Radiology

Article Title: Balloon-occluded retrograde transvenous obliteration for duodenal varices: a retrospective observational study

doi: 10.1093/bjr/tqag046

Figure Lengend Snippet: A 71-year-old woman with duodenal varices. (A) Preoperative contrast-enhanced CT shows varices (arrow) in the second-third portion of the duodenum. (B) Endoscopy shows tortuous and dilated varices in the duodenal wall. (C) Volume-rendering reconstruction of contrast-enhanced CT shows duodenal varices (yellow) that have the fenestrated inferior pancreaticoduodenal vein as an afferent vein (red) that directly drained into the IVC through the mesocaval collateral vessel (green). (D) BRTV using a 5-Fr balloon catheter (arrow) inserted through the IVC showed tortuous and dilated vessels including the varices. (E) A microcatheter inserted through the 5-Fr balloon catheter (arrow) was placed close to the varices, and 9 mL of 5% EOI was injected. (F) Coil embolization (arrowhead) of the efferent vein was performed to prevent outflow of the sclerosant. Abbreviations: BRTV = balloon-occluded retrograde transvenous venography; CT = computed tomography; EOI = ethanolamine oleate iopamidol; IVC = inferior vena cava.

Article Snippet: After achieving appropriate visualization of the varices by BRTV, 5% ethanolamine oleate iopamidol (EOI), prepared by mixing 10% ethanolamine oleate (Oldamin, Takeda Pharmaceutical, Osaka, Japan) and the same amount of iopamidol (300 mgI Iopamiron, Bayer Yakuhin, Osaka, Japan), was injected under balloon occlusion of the main drainage vein until the varices were visualized.

Techniques: Injection, Computed Tomography