Fig. 2. A 60-year-old male with ruptured duodenal varices. (A) Contrast-enhanced computed tomography (CT) showed the varices in the second and third portions of the duodenum (arrows). The afferent vein was the inferior pancreaticoduodenal vein (asterisk) and the efferent vein drained into the right gonadal vein (arrowhead). (B) Endoscopy showed active bleeding from the duodenal varices. Hemostasis could be achieved by clipping (not shown). (C) Retrograde venography under balloon occlusion of the right gonadal vein did not demonstrate the main efferent vein. The arrow indicates the clip placed on the duodenal varices. (D) After coil embolization of the right gonadal vein, the main efferent vein was demonstrated. However, a retrograde venogram obtained through the microcatheter advanced into the main efferent vein demonstrated an anastomosis with the retroperitoneal veins (arrow). (E) Therefore, the collateral vein was also embolized with coils. Infusions of ethanolamine oleate with iopamidol for 30 minutes were then repeated three times. The arrow indicates the clip and the arrowhead indicates the inferior pancreaticoduodenal vein. The asterisk indicates the microcatheter. (F) Contrast-enhanced CT performed 3 days after balloon-occluded retrograde transvenous obliteration (BRTO) showed that the varices were completely thrombosed (arrows). The arrowhead indicates the clip placed on the varices and the asterisk indicates the inferior pancreaticoduodenal vein. (G) Endoscopy per- formed 1 week after BRTO showed an ulcer at the clipping site.
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