Interventional Radiology for Bleeding Ectopic Varices

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after February 10, 2026:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 0.50
Procedures: 0.50
Abdomen and Pelvis: 0.50

Magnetic Resonance Imaging: 0.50
Procedures: 0.50
Body: 0.50

Registered Radiologist Assistant: 2.25
Procedures: 2.25
Abdominal Section: 2.25

Vascular-Interventional Radiography: 2.25
Procedures: 2.25
Vascular Interventional Procedures: 2.25

Vascular Sonography: 0.25
Procedures: 0.25
Extracranial Cerebral Vasculature and Other Sonographic Procedures: 0.25

Outline

1. Introduction
2. Cause
3. Diagnosis
4. Anatomic Locations and Symptoms
5. Endoscopic and Surgical Management
6. Management and Interventional Radiology
   1. General Principles in Planning
   2. Transjugular Intrahepatic Portosystemic Shunt
   3. Retrograde Transvenous Obliteration
7. Antegrade Transvenous Obliteration
   1. Portal Venous Recanalization
8. Specific Considerations
   1. Duodenal Varices
   2. Jejunobiliary Anastomotic Varices
   3. Stomal Varices
   4. Rectal Varices
9. Conclusion

Objectives

Upon completion of this course, students will:

1. define ectopic varices
2. identify common endoscopic sites for ectopic varices
3. describe interventional radiology’s role in the management of ectopic varices
4. explain the body’s natural mechanisms that prevent variceal formation in healthy individuals
5. identify other causes of ectopic varices beyond global portal hypertension
6. describe the role of contrast-enhanced CT in diagnosing and planning treat-ment for ectopic varices
7. identify the CT phase that can show active variceal bleeding
8. recognize an additional study useful for detecting intermittent bleeding sources
9. identify the afferent veins supplying rectal varices
10. correlate specific gastrointestinal bleeding symptoms with the presence of varices
11. list the limitations of endoscopic management for ectopic varices
12. explain why there is a shift from surgical to endovascular therapies for ec-topic varices
13. analyze the treatment algorithm for suspected ectopic varices
14. identify the preferred vascular access route when a TIPS is present or needed to treat ectopic varices
15. differentiate the effectiveness of TIPS versus TIPS alone for bleeding ecto pic varices
16. describe the mechanism of action of RTO for ectopic varices
17. identify the purpose of adding gelatin sponge particles to sclerosants during RTO
18. describe the mechanism of action of ATO for ectopic varices
19. identify common sclerosant agents used in interventional procedures
20. identify common liquid embolic agents used in interventional procedures
21. recognize the rationale for performing portal venous recanalization during ATO procedures
22. identify an additional interventional procedure for duodenal varices
23. explain why ATO with liquid embolic agents might be the primary treatment for jejunobiliary anastomotic varices
24. identify essential technical considerations when performing ATO with NBCA for jejunobiliary anastomotic varices
25. describe the challenges of endoscopic management of stomal varices
26. identify the most common endovascular access route for ATO of stomal vari-ces
27. identify alternative vascular access options for rectal varices
28. discuss factors contributing to the rise of endovascular intervention treat-ment for ectopic varices