Interventional Radiology: Percutaneous Transhepatic Obliteration and Transileocolic Obliteration

Transportal obliteration is a technique used in portal hypertension to embolize the collateral veins of the portal system. It is used to treat refractory esophagogastric varices, ectopic varices, or portal-systemic encephalopathy. After insertion of a 5-French long sheath introducer into the portal vein, a catheter is inserted directly into the vein, and the portal circulation is visualized by portography. A balloon catheter is inserted selectively into the inflow site of the veins feeding the varices. Sclerosant is injected to obliterate the feeding vein or veins, and steel coils are used to complete the obliteration. However, the rate of complete disappearance of varices is not high after transportal obliteration alone. Transportal obliteration combined with endoscopic treatment or balloon-occluded retrograde transvenous obliteration, or both, is useful for treating uncontrolled bleeding from varices. The most frequent complication of percutaneous transhepatic obliteration is intraperitoneal bleeding. Severe coagulopathy is a contraindication for both percutaneous transhepatic obliteration and transileocolic vein obliteration, and ascites is a contraindication for percutaneous transhepatic obliteration. The presence of collateral veins decreases portal venous pressure. Obliteration of these veins by transportal obliteration thus increases portal congestion and portal pressure, especially in patients with cirrhosis. Partial splenic embolization has been performed incrementally to reduce portal venous pressure to the level it was before obliteration of the collateral veins. Transportal obliteration in combination with endoscopic treatment or with other forms of interventional radiology is useful for treating refractory esophagogastric varices, ectopic varices, or portal-systemic encephalopathy.