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Balloon-occluded retrograde transvenous obliteration of a gastric varix via the left inferior phrenic vein

Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi Hirokoji, Kamigyo-ku 602-8566, Kyoto, Japan

Correspondence: Tomohiro Matsumoto, Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi Hirokoji, Kamigyo-ku 602-8566, Kyoto, Japan. E-mail: t-matsu{at}koto.kpu-m.ac.jp

We encountered a patient with a gastric varix that drained through the left inferior phrenic vein, which directly entered the inferior vena cava at the point just inferior to the diaphragm. In this patient, gastrorenal shunt was not seen. Balloon-occluded retrograde transvenous obliteration of the gastric varix was performed, in which 50% glucose and 5% ethanolamine oleate–iopamidol were injected as sclerosing agents while the balloon was inflated in the left inferior phrenic vein. 1 week after the procedure, the disappearance of enhancement in the gastric varix was confirmed on contrast-enhanced multidetector row CT. Furthermore, a significant reduction in the size of the varix was confirmed on endoscopic examination 4 months later.