Case report demonstrates successful gastric variceal shrinkage in liver cirrhosis using an inverted catheter tip technique, highlighting a viable route when balloon catheter access fails.
Background: Bleeding from gastric varices can be life-threatening. Balloon-occluded retrograde transvenous obliteration is one of the treatments for gastric varices. The obliteration via other efferent veins than gastrorenal shunts has only rarely been reported. In such cases, it is sometimes difficult to insert the catheter close to the gastric varices because of the narrowness and tortuosity of the vein.Case presentation: A 70-year-old woman with liver cirrhosis was admitted to our hospital for treatment of growing gastric varices in the fundus. Computed tomography showed gastric varices continuously draining the pericardiophrenic vein via the inferior phrenic vein. Balloon-occluded retrograde transvenous obliteration by a transjugular approach was planned. However, a conventional balloon catheter or micro balloon catheter could not be inserted into the efferent vein near the varices because of the narrowness and tortuosity of the vein. Hence, coil-assisted retrograde transvenous obliteration was performed by an inverted catheter tip technique using a single conventional microcatheter. At 2 months after procedure, endoscopy showed shrinkage of the gastric varices.Conclusions: The inverted catheter tip technique might be useful for cases in which it is difficult to insert a balloon catheter into the efferent vein.
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