Approach route
Transfemoral
Transjugular
Efferent vein embolization
Intra-procedural Cone-Beam CT protocol
The role of CBCT in determining technical success
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CBCT provides endpoint of gelfoam injection
√ Easily difine extent of embolization
√ Identifying nonfilling varices and veins
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Visualization of incomplete embolization on CBCT in two patients
√ Increased technical success rate
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A flat-panel detector angiographic system
(AXIOM Artis Zee; Siemens, Erlangen, Germany)
Scan time: 7 sec
Total scanning angle, 200°
Rotation speed, 30°/s
Total of 396 projections (30 frames/sec)
Matrix size, 512 x 512
Isotropic voxel size, 0.49 mm
Effective field of view, 382 x 296 mm2
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contrast CT images：afferent vein |
Proximal part of afferent vein was identified on the fluoroscopy |
JVIR, 2015, Gwon DI et al
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JVIR, 2015, Gwon DI et al. |
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Before PARTO |
CBCT provides endpoint of gelfoam injectio
√ Easily difine extent of embolization
√ Identifying nonfilling varices and veins
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10mm AVP II |
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Before PARTO |
After PARTO |
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Before PARTO |
After PARTO |
CASE 2. A 48-yr woman with two dominant gastrorenal shunt with GV s/p LT d/t alcoholic LC
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Before PARTO |
1st embolization |
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1st embolization：incomlete thrombosis of GV |
1st CBCT |
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2nd embolization |
2nd CBCT |
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1 day after PARTO |
4 Mo after PARTO |
PARTO is technically simple and safe and is clinically effective for the treatment of GV and HE.
Intra-procedural CBCT can be considered as an adjunct tool to fluoroscopy during PARTO.
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