Transhepatic Catheterization and Obliteration of the Coronary Vein in Patients with Portal Hypertension and Esophageal Varices

TLDR

The authors developed a transhepatic catheterization technique that accesses the coronary vein via the portal vein and, upon confirming retrograde flow, injects glucose and thrombin to obliterate esophageal varices. Portography guided the catheter placement and monitored the procedure’s effectiveness. In a series of four patients, including two with active bleeding, the technique achieved complete coronary vein obliteration in all cases. Published in N Engl J Med 291:646–649, 1974.

Abstract

For the management of esophageal varices complicating portal hypertension, we have developed a method that consists of (1) percutaneous transhepatic portal venipuncture, (2) manipulation of a catheter via the portal vein into the coronary vein, and, (3) if injection of contrast medium demonstrates retrograde flow through that vein as well as esophageal varices, injection of 30 ml of 50 per cent glucose solution followed by injection of a small amount of thrombin solution. Portography is used throughout to facilitate the procedure and assess results. Four patients have been treated, two of them with variceal bleeding. In all four, obliteration of the coronary vein by this method was successful. (N Engl J Med 291:646–649, 1974)