Display options
Cite
Lee EW, Saab S, Gomes AS, et al. Coil-Assisted Retrograde Transvenous Obliteration (CARTO) for the Treatment of Portal Hypertensive Variceal Bleeding: Preliminary Results. Clin Transl Gastroenterol. 2014;5:e61doi: 10.1038/ctg.2014.12.
Lee, E. W., Saab, S., Gomes, A. S., Busuttil, R., McWilliams, J., Durazo, F., Han, S. H., Goldstein, L., Tafti, B. A., Moriarty, J., Loh, C. T., & Kee, S. T. (2014). Coil-Assisted Retrograde Transvenous Obliteration (CARTO) for the Treatment of Portal Hypertensive Variceal Bleeding: Preliminary Results. Clinical and translational gastroenterology, 5e61. https://doi.org/10.1038/ctg.2014.12
Lee, Edward W, et al. "Coil-Assisted Retrograde Transvenous Obliteration (CARTO) for the Treatment of Portal Hypertensive Variceal Bleeding: Preliminary Results." Clinical and translational gastroenterology vol. 5 (2014): e61. doi: https://doi.org/10.1038/ctg.2014.12
Lee EW, Saab S, Gomes AS, Busuttil R, McWilliams J, Durazo F, Han SH, Goldstein L, Tafti BA, Moriarty J, Loh CT, Kee ST. Coil-Assisted Retrograde Transvenous Obliteration (CARTO) for the Treatment of Portal Hypertensive Variceal Bleeding: Preliminary Results. Clin Transl Gastroenterol. 2014 Oct 02;5:e61. doi: 10.1038/ctg.2014.12. PMID: 25273155; PMCID: PMC4218931.
Copy Download .nbib Format: NLM
Share it on

Clin Transl Gastroenterol. 2014 Oct 02;5:e61. doi: 10.1038/ctg.2014.12.

Coil-Assisted Retrograde Transvenous Obliteration (CARTO) for the Treatment of Portal Hypertensive Variceal Bleeding: Preliminary Results.

Clinical and translational gastroenterology

Edward W Lee, Sammy Saab, Antoinette S Gomes, Ronald Busuttil, Justin McWilliams, Francisco Durazo, Steven-Huy Han, Leonard Goldstein, Bashir A Tafti, John Moriarty, Christopher T Loh, Stephen T Kee

Affiliations

  1. Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
  2. Division of Hepatology, Department of Medicine, Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, California, USA.
  3. Dumont-UCLA Transplant Center, Pfleger Liver Institute, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, California, USA.

PMID: 25273155 PMCID: PMC4218931 DOI: 10.1038/ctg.2014.12

Abstract

OBJECTIVES: To describe the technical feasibility, safety, and clinical outcomes of coil-assisted retrograde transvenous obliteration (CARTO) in treating portal hypertensive non-esophageal variceal hemorrhage.

METHODS: From October 2012 to December 2013, 20 patients who received CARTO for the treatment of portal hypertensive non-esophageal variceal bleeding were retrospectively evaluated. All 20 patients had at least 6-month follow-up. All patients had detachable coils placed to occlude the efferent shunt and retrograde gelfoam embolization to achieve complete thrombosis/obliteration of varices. Technical success, clinical success, rebleeding, and complications were evaluated at follow-up.

RESULTS: A 100% technical success rate (defined as achieving complete occlusion of efferent shunt with complete thrombosis/obliteration of bleeding varices and/or stopping variceal bleeding) was demonstrated in all 20 patients. Clinical success rate (defined as no variceal rebleeding) was 100%. Follow-up computed tomography after CARTO demonstrated decrease in size with complete thrombosis and disappearance of the varices in all 20 patients. Thirteen out of the 20 had endoscopic confirmation of resolution of varices. Minor post-CARTO complications, including worsening of esophageal varices (not bleeding) and worsening of ascites/hydrothorax, were noted in 5 patients (25%). One patient passed away at 24 days after the CARTO due to systemic and portal venous thrombosis and multi-organ failure. Otherwise, no major complication was noted. No variceal rebleeding was noted in all 20 patients during mean follow-up of 384±154 days.

CONCLUSIONS: CARTO appears to be a technically feasible and safe alternative to traditional balloon-occluded retrograde transvenous obliteration or transjugular intrahepatic portosystemic shunt, with excellent clinical outcomes in treating portal hypertensive non-esophageal variceal bleeding.

References

  1. Eur Radiol. 2011 Jan;21(1):122-9 - PubMed
  2. Tech Vasc Interv Radiol. 2012 Sep;15(3):241-53 - PubMed
  3. Surgery. 2001 Apr;129(4):414-20 - PubMed
  4. Clin Liver Dis. 2001 Aug;5(3):645-63 - PubMed
  5. Br J Radiol. 2009 Nov;82(983):930-5 - PubMed
  6. Am J Gastroenterol. 1997 Jun;92(6):1026-30 - PubMed
  7. Radiology. 2013 Jul;268(1):281-7 - PubMed
  8. Korean J Radiol. 2003 Apr-Jun;4(2):109-16 - PubMed
  9. Clin Mol Hepatol. 2012 Dec;18(4):368-74 - PubMed
  10. Radiographics. 2013 Jan-Feb;33(1):100-1 - PubMed
  11. J Gastroenterol Hepatol. 2008 Nov;23(11):1702-9 - PubMed
  12. J Vasc Interv Radiol. 2011 Mar;22(3):309-16; quiz 316 - PubMed
  13. Korean J Radiol. 2007 Nov-Dec;8(6):520-30 - PubMed
  14. Semin Intervent Radiol. 2011 Sep;28(3):333-8 - PubMed
  15. Clin Liver Dis. 2001 Aug;5(3):727-67, x - PubMed
  16. Abdom Imaging. 2005 May-Jun;30(3):306-13 - PubMed
  17. AJR Am J Roentgenol. 2002 May;178(5):1167-74 - PubMed
  18. J Gastroenterol Hepatol. 2010 Jun;25(6):1129-35 - PubMed
  19. Am J Gastroenterol. 1999 Mar;94(3):643-9 - PubMed
  20. Radiology. 1999 May;211(2):349-56 - PubMed
  21. Endoscopy. 1990 May;22(3):151 - PubMed
  22. J Vasc Interv Radiol. 2001 Mar;12(3):327-36 - PubMed
  23. Surgery. 2010 Jul;148(1):145-50 - PubMed
  24. Cardiovasc Intervent Radiol. 1998 Jan-Feb;21(1):27-30 - PubMed
  25. AJR Am J Roentgenol. 2005 Apr;184(4):1340-6 - PubMed
  26. ISRN Gastroenterol. 2012;2012:919371 - PubMed
  27. Hepatol Res. 2008 Apr;38(4):340-7 - PubMed
  28. Clin Gastroenterol Hepatol. 2014 Jun;12(6):919-28.e1; quiz e51-2 - PubMed
  29. Cardiovasc Intervent Radiol. 2010 Dec;33(6):1257-61 - PubMed
  30. Korean J Intern Med. 1994 Jul;9(2):125-7 - PubMed
  31. J Vasc Interv Radiol. 2008 Apr;19(4):529-38 - PubMed
  32. Hepatology. 1992 Dec;16(6):1343-9 - PubMed
  33. Am J Gastroenterol. 1996 Dec;91(12):2594-7 - PubMed
  34. AJR Am J Roentgenol. 2007 Dec;189(6):W365-72 - PubMed
  35. J Gastroenterol Hepatol. 1996 Jan;11(1):51-8 - PubMed
  36. J Gastroenterol. 2005 Oct;40(10):964-71 - PubMed
  37. J Gastroenterol. 2007 Aug;42(8):663-72 - PubMed
  38. AJR Am J Roentgenol. 1996 Nov;167(5):1317-20 - PubMed

Publication Types