Digital imaging erases the background and causes percutaneous esophageal varices occlusion

This article is professionally consulted by Master, Doctor Vu Huy Hoang - Radiologist - Department of Diagnostic Imaging and Nuclear Medicine - Vinmec Times City International Hospital. Doctor Vu Huy Hoang has 10 years of experience working in the field of diagnostic imaging.

Esophageal varices are enlarged veins that increase in size and protrude above the lining of the esophagus. This is a potentially life-threatening condition if they rupture and bleed. Treatment is aimed at preventing varicose veins and controlling bleeding if it occurs. In which, percutaneous digitization and occlusion of esophageal varices is a preferred technique chosen with minimal intervention.

Esophageal varices are an unusual condition with portal hypertension commonly associated with cirrhosis. At this point, the veins become dilated, enlarged, protruding above the mucosa and protruding into the lumen of the esophagus.
Esophageal varices usually do not cause any signs and symptoms unless they cause bleeding. This is when a person vomits large amounts of bright red blood or passes black, tarry, or dark bloody stools. Acute and severe anemia will make the patient pale, drop blood pressure and lose consciousness in severe cases or coma, death. At this time, emergency hemostasis treatment is essential to ensure the patient's life.
The main aim in the treatment of esophageal varices is to prevent bleeding and to stop bleeding if it has occurred. Specifically, the measures are using drugs to reduce pressure in the portal vein, drugs to reduce visceral blood flow, intervention to tie elastic bands or sclerotherapy of veins through endoscopy, intervention to create a catheter between the portal vein and the vein. Hepatobiliary tract infection (TIPS), balloon pump compresses the esophagus and causes percutaneous esophageal varices occlusion.

Percutaneous digitization of the background and occlusion of esophageal varices is an endovascular interventional procedure. Under the magnifying screen, the site of esophageal varices that may or may not have ruptured is approached and endovascular embolization material is injected. As a result, the blood flow is prevented from circulating, the bleeding phenomenon will be prevented from running or reducing the tension of the varicose veins, thus reducing the risk of rupture.
In general, the treatment of esophageal varices is somewhat less effective than endoscopic elastic band ligation or sclerotherapy in the prevention of upper gastrointestinal bleeding due to portal hypertension. in cirrhotic patients. However, this method is remarkably effective in cases of active bleeding due to acute esophageal varices that are not controlled by medical therapy or endoscopic intervention. Therefore, esophageal varices with bleeding complications not controlled by endoscopic intervention is the main indication of this procedure.

Because it is a sophisticated technique that requires sophistication, patients and relatives need to be thoroughly explained about the procedure to be performed, as well as the associated risks, in order to request cooperation. Next, the patient needs to fast or not fast because in an emergency situation, change into appropriate clothes and arrange to lie on his back on the intervention table, place an intravenous line with 0 physiological saline solution. 9%. Means of monitoring breathing, pulse, blood pressure, electrocardiogram, SpO2 are mounted on the patient and the indicators are displayed on the screen for easy observation. After cleaning the right hypochondrium, the doctor will cover the area with a sterile tissue to prepare for intervention. In case the patient is overstimulated and poorly cooperated, it is necessary to consider appointing a sedative to facilitate the process.
To open the way to the portal vein, the doctor will numb the area, make an incision in the skin. The set of ultra-small needles with the size of 21G will be inserted into the right branch of the portal vein in the liver, usually the branch in the lower segments V, VI. A tube measuring 6F will be placed into the lumen. Next, the doctor will take an angiogram to evaluate the lesion by inserting a Cobra catheter and wire into the superior mesenteric vein.
Then, the Cobra catheter will be replaced by an angiographic catheter with a pigtail curved tip and located in the superior mesenteric vein, just below the confluence with the splenic vein. At this time, by digital scanning of the background, the portal vein system outside and inside the liver will be visible when contrast is injected. Under the fluorescent screen, the doctor will evaluate the system of collateral branches and varicose veins of the esophagus that are ruptured causing bleeding into the upper digestive tract.

Once the site of the lesion has been observed, the physician will approach using a Cobra catheter to select the root of the varicose veins of the esophagus. A microcatheter will then be inserted into the varicose veins of the esophagus through the Cobra catheter for ultra-selective angiography through the microcatheter to confirm how the varicose vein is and how the ruptured mouth is causing the bleeding.
Here, the doctor conducts interventional treatment of varicose veins of the esophagus with a metal helix or bio-glue material. When the material is injected into the varicose vein, the flow is stopped and stopped. However, before concluding, the clinician should evaluate the intervention by replacing the Cobra catheter with an angiographic catheter with a pigtail curved tip with the tip in the superior mesenteric vein, just below the joint position. splenic vein drainage.
The external and intrahepatic portal vein system was once again digitalized to erase the background, the internal and extrahepatic portal vein branches circulate normally, without thrombus. At the same time, the doctor will also evaluate the system of collateral branches and varicose veins of the esophagus, especially the bleeding site has been completely blocked by intervention, no longer has residual communication with the portal vein system. . In addition, the preliminary ultrasound examination also did not show hematoma around the liver and abdomen.
When the above requirements have been met, this procedure will end. The doctor will remove the entire catheter, microcatheter and wire out. However, when the tip of the tube into the lumen is 3-4cm away from the abdominal wall, the retraction speed should be slowed down and the portal vein branch plug should be immediately applied with a metal helix or bio-foam at this position as a precaution. abdominal bleeding. Finally, when the patient is evaluated for gastrointestinal bleeding due to esophageal varices after the intervention, he can go back to the room.

The liver is a large organ, the internal structure of which contains the portal vein system - the return of almost the entire intra-abdominal visceral system, contributing a fairly large outflow to the inferior vena cava. about heart. Accordingly, digital imaging erases the background and causes occlusion of esophageal varices through the skin, as well as all other interventions to the liver, always contains certain risks of trauma. Among them, two common complications are:
Abdominal bleeding due to rupture of the hepatic capsule and portal vein branch: To actively prevent, it is necessary to use a very small needle with a size of 21G and perform it immediately. portal vein occlusion before withdrawing the lumen from the liver. Abdominal bleeding due to rupture of intercostal artery, abdominal wall: This complication occurs when poking into the liver parenchyma, causing damage to the intercostal and lumbar arteries. To resolve, it is necessary to continue DSA angiography, find the bleeding site and perform hemostasis with available materials.

In summary, percutaneous intervention to treat esophageal varices by occlusion with artificial materials is a radical approach in cases of esophageal varices. When the patient's condition is critical, endoscopic interventions cannot be performed or do not respond, causing esophageal varices occlusion with minimal intervention and high hemostatic efficiency. priority should be taken.