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Digestive Disease Interventions
DOI: 10.1055/s-0044-1789217
Review Article

Interventional Management of Variceal Bleeding: Techniques and Emerging Concepts

Ranjan Kumar Patel 
1   Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Taraprasad Tripathy
1   Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Amar Mukund
2   Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
,
Manas Kumar Panigrahi
3   Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Bramhadatta Pattnaik
4   Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Srikant Behera
5   Department of General Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Hemanta Kumar Nayak
3   Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
› Author Affiliations Funding None.
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Abstract

Despite technical advancements and disease understanding, variceal bleeding remains the leading cause of mortality in patients with cirrhosis. Endoscopic therapies are the main cornerstone of therapy in variceal bleeding. Interventional radiology (IR) plays a significant role in managing variceal bleeding, especially in cases where endoscopic therapies are not feasible or failed. Cross-sectional imaging is often critical to identify relevant anatomy before IR therapies. Transjugular intrahepatic portosystemic shunt (TIPS) is indicated as salvage therapy in patients with refractory variceal bleeding. Retrograde transvenous variceal embolization (RTO) procedures provide superior bleeding control in patients with gastric and ectopic varices, however, without increasing the risk of hepatic encephalopathy and liver function deterioration. Antegrade transvenous obliteration is a viable alternative when RTO is not feasible. Left-sided portal hypertension is a distinct entity resulting from splenic vein stenosis or occlusion, and variceal bleeding in left-sided portal hypertension does not respond to TIPS, requiring variceal embolization, partial splenic embolization, or splenic vein recanalization. Occasionally, endovascular splenorenal or mesorenal shunt and splenic vein occlusion with distal splenorenal diversion are performed to control variceal bleeding. This article entails the basic concepts and procedural aspects of various interventional radiological procedures performed in patients with variceal bleeding.

Keywords

variceal bleeding - gastric varices - TIPS - BRTO - interventional radiology

Informed Consent

Informed consent has been obtained from the patient for the publication of this case and accompanying images.


Financial Disclosure

None.




Publication History

Received: 15 May 2024

Accepted: 24 July 2024

Article published online:
19 August 2024

© 2024. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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