Assessment of hemodynamic changes in gastric varices using CT findings before and after vascular plug-assisted retrograde transvenous obliteration (PARTO) and evaluation of treatment outcomes.

Abstract

Purpose: To assess the treatment outcomes of vascular plug-assisted retrograde transvenous obliteration (PARTO) for gastric varices based on hemodynamic changes observed in pre- and post-procedural CT scans.

Methods: This single-center study included 43 patients with gastric varices who underwent PARTO between June 2017 and December 2023. Peri-procedural CT and endoscopic findings were retrospectively reviewed to analyze the afferent and draining veins of gastric varices, identify any residual varices or afferent veins after treatment, assess the technical and clinical successes, and determine statistically significant variables associated with clinical success.

Results: In the pre-procedural CT, the most common dominant afferent vein was the posterior gastric vein (81.4%), followed by the short gastric vein (46.5%) and the left gastric vein (37.2%). Post-procedural CT scans were available for 34 patients (34/43), revealing residual varices and afferent veins in 10 patients (10/34). Seven patients had unknown clinical outcomes due to insufficient follow-up data. The technical and clinical success rates were 93.0% (40/43) and 77.8% (28/36), respectively. In the multivariable logistic regression model, the dominant left gastric vein observed in the pre-procedural CT was a significant negative predictor of clinical success (odds ratio, 0.007; P = 0.027). The sum of the diameters of all afferent veins was also a significant negative predictor (odds ratio, 0.708; P = 0.044).

Conclusion: A dominant left gastric vein and a larger sum of the diameters of all afferent veins observed in the pre-procedural CT may be associated with an increased risk of clinical failure of PARTO. Therefore, pretherapeutic CT evaluation of the hemodynamics of gastric varices, particularly the type, dominance, and diameter of the afferent veins, could be beneficial for achieving successful PARTO.