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)
- 1.3k Downloads
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.
KeywordsPortal hypertension Varices Embolization
Balloon-occluded antegrade transvenous obliteration
Balloon-occluded retrograde transvenous obliteration
Coil-assisted retrograde transvenous obliteration
Ethanolamine oleate iopamidol
Plug-assisted retrograde transvenous obliteration
Percutaneous transhepatic obliteration
Sodium tetradecyl sulfate
Transileocolic vein obliteration
Transjugular intrahepatic portosystemic shunt
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
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.
For this type of study, formal consent is not required.
- 15.Shimoda R, Horiuchi K, Hagiwara S, Suzuki H, Yamazaki Y, Kosone T, et al. Short-term complications of retrograde transvenous obliteration of gastric varices in patients with portal hypertension: effects of obliteration of major portosystemic shunts. Abdom Imaging. 2005;30:306–13.CrossRefPubMedGoogle Scholar
- 22.Kim YH, Kim YH, Kim CS, Kang UR, Kim SH, Kim JH. Comparison of balloon-occluded retrograde transvenous obliteration (BRTO) using ethanolamine oleate (EO), BRTO using sodium tetradecyl sulfate (STS) foam and vascular plug-assisted retrograde transvenous obliteration (PARTO). Cardiovasc Interv Radiol. 2016;39:840–6.CrossRefGoogle Scholar
- 28.Saad WE, Sze DY. Variations of balloon-occluded retrograde transvenous obliteration (BRTO): balloon-occluded antegrade transvenous obliteration (BATO) and alternative/adjunctive routes for BRTO. Semin Interv Radiol. 2011;28(314–24):26.Google Scholar