ARRS 2022 Abstracts

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E1886. Management of Variceal Hemorrhage: An Update
Authors
  1. Aliaksei Salei; University of Alabama at Birmingham
  2. Theresa Caridi; University of Alabama at Birmingham
  3. Husameddin El Khudari; University of Alabama at Birmingham
  4. Kiera Murphy; University of Alabama at Birmingham
  5. Junjian Huang; University of Alabama at Birmingham
  6. Andrew Gunn; University of Alabama at Birmingham
Background
Variceal hemorrhage is a morbid condition that frequently requires involvement of interventional radiology (IR). Primary image-guided therapies for variceal hemorrhage include a transjugular intrahepatic portosystemic shunt (TIPS) and various modifications of transvenous obliteration (TO). Knowledge of variceal pathophysiology and anatomy, current techniques, and the evidence supporting therapeutic selection is paramount to successful patient outcomes. The purpose of this exhibit is to provide the framework of the available evidence on image-guided management of variceal hemorrhage and illustrate pertinent clinical and anatomic scenarios.

Educational Goals / Teaching Points
This exhibit aims to review anatomic and clinical considerations pertinent to management of varices; review available evidence and applicable guidelines defining role of interventional radiology in management of variceal hemorrhage as well as choice of interventional therapy; and provide a pictorial review of clinical and anatomic scenarios.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit includes a review of anatomic considerations (types of varices; Sarin classification of gastric varices; and common patterns of venous supply and drainage of various types of varices); management of gastroesophageal varices without a splenorenal shunt (preemptive or “early” TIPS; rescue or salvage therapy; review of available evidence and clinical guidelines; and technical consideration including need for embolization of gastroesophageal varices in conjunction with TIPS); management of gastroesophageal varices with a splenorenal shunt (review of available evidence and clinical guidelines and choice of treatment modality: TIPS, TO, or both?); ectopic varices; and approaches to successful hemostasis.

Conclusion
Variceal bleeding frequently mandates involvement of IR to achieve successful and sustained hemostasis. Knowledge of variceal pathophysiology and anatomy in addition to an individualized, multidisciplinary, and patient-centered approach, are key to successful outcomes.