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Review
. 2021 Oct 28;27(40):6874-6887.
doi: 10.3748/wjg.v27.i40.6874.

Endoscopic ultrasound-guided vascular interventions: Current insights and emerging techniques

Rupinder Mann  1 , Hemant Goyal  2 , Abhilash Perisetti  3 , Saurabh Chandan  4 , Sumant Inamdar  5 , Benjamin Tharian  5
Affiliations
Review

Endoscopic ultrasound-guided vascular interventions: Current insights and emerging techniques

Rupinder Mann et al. World J Gastroenterol. .

Abstract

Endoscopic ultrasound (EUS) is one of the significant breakthroughs in the field of advanced endoscopy. In the last two decades, EUS has evolved from a diagnostic tool to a real-time therapeutic modality. The luminal gastrointestinal (GI) tract provides a unique opportunity to access multiple vascular structures, especially in the mediastinum and abdomen, thus permitting a variety of EUS-guided vascular interventions. The addition of the doppler and contrast-enhanced capability to EUS has further helped provide real-time visualization of blood flow in vessels through the GI tract. EUS-guided vascular interventions rely on standard endoscopic accessories and interventional tools such as fine-needle aspiration needles and fine-needle biopsy. EUS allows the visualization of various structures in real-time by differentiating tissue densities and vascularity, thus, avoiding radiation exposure. EUS-guided techniques also allow real-time microscopic examination after target biopsy. Furthermore, many necessary interventions can be done during the same procedure after diagnosis. This article provides an overview of EUS-guided vascular interventions such as variceal, non-variceal bleeding interventions, EUSguided portal vein (PV) access with the formation of an intrahepatic portosystemic shunt, and techniques related to diagnosis of GI malignancies. Furthermore, we discuss current insights and future outlook of therapeutic modalities like PV embolization, PV sampling, angiography, drug administration, and portal pressure measurement.

Keywords: Endoscopic ultrasound; Esophageal varices; Gastric varices; Portal vein; Therapeutic endoscopy; Vascular intervention.

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Conflict of interest statement

Conflict-of-interest statement: Rupinder Mann, Hemant Goyal, Abhilash Perisetti, Saurabh Chandan, Sumant Inamdar has nothing to disclose; Benjamin Tharian acts as a consultant to Boston Scientific and Medtronic which are not relevant for this manuscript.

Figures

Figure 1
Figure 1
Endoscopic ultrasound history. EUS: Endoscopic ultrasound; FNA: Fine-needle aspiration; Rx: Treatment.
Figure 2
Figure 2
Different types of endoscopic ultrasound guided vascular interventions. PV: Portal vein; EUS: Endoscopic ultrasound; GI: Gastrointestinal.
See this image and copyright information in PMC

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