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CardioVascular and Interventional Radiology

, Volume 41, Issue 6, pp 835–847 | Cite as

Modified Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) Techniques for the Treatment of Gastric Varices: Vascular Plug-Assisted Retrograde Transvenous Obliteration (PARTO)/Coil-Assisted Retrograde Transvenous Obliteration (CARTO)/Balloon-Occluded Antegrade Transvenous Obliteration (BATO)

  • David J. Kim
  • Michael D. Darcy
  • Naganathan B. Mani
  • Auh Whan Park
  • Olaguoke Akinwande
  • Raja S. Ramaswamy
  • Seung Kwon KimEmail author
Review

Abstract

Gastric varices in the setting of portal hypertension occur less frequently than esophageal varices but occur at lower portal pressures and are associated with more massive bleeding events and higher mortality rate. Balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices has been well documented as an effective therapy for portal hypertensive gastric varices. However, BRTO requires lengthy, higher-level post-procedural monitoring and can have complications related to balloon rupture and adverse effects of sclerosing agents. Several modified BRTO techniques have been developed including vascular plug-assisted retrograde transvenous obliteration, coil-assisted retrograde transvenous obliteration, and balloon-occluded antegrade transvenous obliteration. This article provides an overview of various modified BRTO techniques.

Keywords

Portal hypertension Varices Embolization 

Abbreviations

BATO

Balloon-occluded antegrade transvenous obliteration

BRTO

Balloon-occluded retrograde transvenous obliteration

CARTO

Coil-assisted retrograde transvenous obliteration

EOI

Ethanolamine oleate iopamidol

EV

Esophageal varices

F

French

GV

Gastric varices

PARTO

Plug-assisted retrograde transvenous obliteration

PTO

Percutaneous transhepatic obliteration

STS

Sodium tetradecyl sulfate

TACE

Transarterial chemoembolization

TIO

Transileocolic vein obliteration

TIPS

Transjugular intrahepatic portosystemic shunt

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

For this type of study, formal consent is not required.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  • David J. Kim
    • 1
  • Michael D. Darcy
    • 1
  • Naganathan B. Mani
    • 1
  • Auh Whan Park
    • 2
  • Olaguoke Akinwande
    • 1
  • Raja S. Ramaswamy
    • 1
  • Seung Kwon Kim
    • 1
    Email author
  1. 1.Interventional Radiology, Mallinckrodt Institute of RadiologyWashington University St. Louis School of MedicineSt. LouisUSA
  2. 2.Interventional RadiologyUniversity of Virginia HospitalCharlottesvilleUSA

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