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Congress: ECR25
Poster Number: C-16319
Type: Poster: EPOS Radiologist (educational)
DOI: 10.26044/ecr2025/C-16319
Authorblock: C. Moreno Lavín, M. Arroyo Lopez, J. M. Cabrera Gonzalez, A. Pla Romero, A. Azcona Pereda, P. Heredia Cachá, A. Sanchez Guerrero, R. San Roman Manso, R. Villar Esnal; Madrid/ES
Disclosures:
Claudia Moreno Lavín: Nothing to disclose
Marta Arroyo Lopez: Nothing to disclose
Jesus Manuel Cabrera Gonzalez: Nothing to disclose
Ana Pla Romero: Nothing to disclose
Andoni Azcona Pereda: Nothing to disclose
Paula Heredia Cachá: Nothing to disclose
Angel Sanchez Guerrero: Nothing to disclose
Ricardo San Roman Manso: Nothing to disclose
Roberto Villar Esnal: Nothing to disclose
Keywords: Interventional vascular, Liver, Veins / Vena cava, Catheter venography, CT-Angiography, Fluoroscopy, Embolisation, Venous access, Haemorrhage, Varices
Learning objectives Understand the complex vascular anatomy of ectopic varices, and analyze the different anatomical locations and haemodynamic characteristics. Optimize imaging modalities for accurate diagnosis and make a proper imaging-based study. Assess endovascular embolization as a therapeutic alternative of bleeding ectopic varices as a rescue alternative when endoscopical management is limited and TIPS is contraindicated.
Read more Background DefinitionThe term ectopic varices refers to any large portosystemic collaterals occurring outside the gastroesophageal region, including portosystemic shunts, gastric varices outside the cardia, rectal varices, internal hemorrhoids, and nongastrointestinal varices [1,3].Although their true prevalence and distribution remain uncertain due to their rarity, ectopic varices present a significant clinical challenge that requires a multidisciplinary approach, with interventional radiology playing an increasingly vital role [1]. A Japanese national survey [2] highlights a discrepancy between endoscopically diagnosed and interventionally treated ectopic varices, suggesting...
Read more Findings and procedure details Diagnosis and interventional radiology managementThe diagnosis of ectopic varices requires a systematic approach in patients with liver disease or portal hypertension [3]. While endoscopy is the first-line tool for gastrointestinal bleeding, it has limitations in assessing ectopic varices. Therefore, contrast-enhanced Computed Tomography (CT), Magnetic Resonance Imaging (MRI) or Doppler ultrasound are crucial for diagnosis and intervention planning [1].Contrast-enhanced CT provides key insights, especially when endoscopic treatment is not feasible due to the anatomical complexity; to make an accurate diagnosis when...
Read more Conclusion Ectopic varices pose a significant clinical challenge due to their rarity and complex vascular anatomy. Effective management requires a multidisciplinary approach, with interventional radiology playing a key role. While endoscopy remains the first-line tool for gastrointestinal bleeding, it is not always effective in these type of complications, being endovascular intervention often required. When TIPS is contraindicated, alternative treatments such as antegrade transvenous obliteration (ATO) and retrograde transvenous obliteration (RTO) offer effective options. Tailored approaches based on anatomical location and hemodynamic...
Read more References Kim H-C, Miyayama S, Lee EW, Lim DY, Chung JW, Jae HJ, et al. Interventional radiology for bleeding ectopic varices: Individualized approach based on vascular anatomy. Radiographics. 2024;44(8). Watanabe N, Toyonaga A, Kojima S, Takashimizu S, Oho K, Kokubu S, et al. Current status of ectopic varices in Japan: Results of a survey by the Japan Society for Portal Hypertension. Hepatol Res. 2010;40(8):763–76. Akhter NM, Haskal ZJ. Diagnosis and management of ectopic varices. Gastrointest Interv. 2012;1(1):3–10. Khalloufi KA. Management of rectal varices in...
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