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RESULTS: INFORMED CONSENT WAS OBTAINED FROM THE PATIENT AFTER EXTENSIVE
DISCUSSION OF RISKS AND BENEFITS OF THE PROCEDURE. MODERATE SEDATION WAS
ADMINISTERED BY A REGISTERED NURSE TRAINED IN PHYSIOLOGIC MONITORING. TOTAL
DURATION OF SEDATION WAS 90 minutes. 120 CC'S OF VISIPAQUE WAS USED
DURING THE EXAM. RADIATION DOSE PRODUCT WAS 488 GRAY/CM2. MULTIPLE DOSE REDUCTION TECHNIQUES WERE USED INCLUDING NONMAGNIFICATION VIEWS, MULTIPLE OBLIQUITIES, AND MINIMAL DSA RUNS.

THE RIGHT GROIN WAS PREPPED AND DRAPED UNDER STERILE CONDITIONS. 1%
LIDOCAINE WAS USED FOR LOCAL ANESTHESIA. ULTRASOUND DOCUMENTED PATENCY OF
THE RIGHT COMMON FEMORAL VEIN. AFTER ACCESS WITH A
MICROPUNCTURE USING STERILE ULTRASOUND GUIDANCE, THE WIRE WAS UPSIZED TO A
NEWTON STRAIGHT GUIDEWIRE. OVER THE WIRE, A 7-FRENCH SHEATH WAS
placed. A Davis catheter was used to select the left renal vein. CONTRAST INJECTION DEMONSTRATED
APPROPRIATE POSITIONING OF THE catheter WITHIN THE LEFT RENAL VEIN.
THROUGH THE SHEATH, A COMBINATION OF A GLIDEWIRE AND A 5-FRENCH ANGLED
CATHETER WAS USED TO ACCESS THE GASTRORENAL SHUNT. CONTRAST INJECTION
DOCUMENTED LARGE GASTRIC VARICES. OVER THE WIRE, A 14 MM PYTHON OCCLUSION
BALLOON CATHETER WAS THEN BROUGHT INTO POSITION AND INFLATED WITHIN THE
GASTRORENAL SHUNT. INITIAL INJECTION DEMONSTRATED THE LARGE GASTRIC VARICES
BUT ALSO DEMONSTRATED A SIGNIFICANT COLLATERAL VESSEL LIKELY AN INFERIOR
PHRENIC VEIN GOING CEPHALAD. THIS COLLATERAL WAS ACCESSED WITH A 3-FRENCH
micro-CATHETER USING THE microwire. A 3 MM micro-COIL WAS THEN DEPLOYED WITHIN
THE VEIN. WITH THE BALLOON
INFLATED, CONTRAST WAS INJECTED TO APPROXIMATE THE VOLUME OF SCLEROSING
AGENT. 12 CC'S OF CONTRAST DEMONSTRATED THE LARGE EXTENT OF THE GASTRIC
VARICES. THE BALLOON WAS LEFT INFLATED AND THE MIXTURE OF GEL FOAM SLURRY
WITH 5% ETHANOLAMINE WAS THEN INJECTED FOR A TOTAL SCLEROSANT VOLUME OF 12
CC'S. THE BALLOON WAS LEFT INFLATED FOR 20 MINUTES. NEXT WITH THE BALLOON
INFLATED, MULTIPLE COILS WERE THEN PLACED WITHIN THE PROXIMAL ASPECT OF THE
GASTRORENAL SHUNT. A TOTAL OF 2 COILS WERE USED TO FORM A COIL BALL.
THE BALLOON WAS THEN SLOWLY DEFLATED WATCHING FOR REFLUX OF
CONTRAST OUT OF THE SHUNT. THERE WAS NO CONTRAST DEMONSTRATED. THE BALLOON
CATHETER WAS THEN SUBSEQUENTLY REMOVED THROUGH THE ANSEL SHEATH. A FINAL
INJECTION WAS PERFORMED WITHIN THE LEFT RENAL VEIN
WHICH DOCUMENTED PATENCY OF THE LEFT RENAL VEIN AND OCCLUSION OF A
GASTRORENAL SHUNT AT THE LEVEL OF THE COIL BALL.

THE SHEATH WAS SUBSEQUENTLY REMOVED AND HEMOSTASIS WAS ACHIEVED WITH MANUAL
COMPRESSION.

NO IMMEDIATE COMPLICATIONS WERE NOTED. THE PATIENT TOLERATED THE PROCEDURE
AND LEFT THE INTERVENTIONAL SUITE IN GOOD CONDITION.
 
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