Hepatology International

, Volume 7, Issue 1, pp 241–247 | Cite as

Short- and long-term clinical outcome after balloon-occluded retrograde transvenous obliteration: is pretreatment portal flow direction a predictive factor?

  • Hidehiro Kamezaki
  • Hitoshi MaruyamaEmail author
  • Taro Shimada
  • Masanori Takahashi
  • Hidehiro Okugawa
  • Osamu Yokosuka
Original Article



To determine whether pretreatment portal flow direction can predict different clinical manifestations or prognosis after balloon-occluded retrograde transvenous obliteration (B-RTO) for gastric varices.


The subjects were 103 cirrhotic patients with medium- or large-grade gastric varices treated by B-RTO. Short- and long-term clinical outcomes were compared among patients with forward portal flow (F group) and those with reversed or to-and-fro portal flow (R group) on color Doppler sonography before B-RTO.


Deterioration of liver function reserve 1 year after B-RTO was more frequent in the R group (34.7 %) than in the F group (11.1 %, p = 0.0251). Thrombotic disorders within 1 year after B-RTO were also more frequent in the R group (20.7 %) than in the F group (2.7 %, p = 0.0079). There was no significant difference in cumulative survival rate of Child class A patients between the two groups. In Child class B or class C patients, however, the cumulative survival rate was poorer in the R group (68.7, 30.5, and 30.5 % at 1, 5, and 9 years, respectively) than in the F group (94.9, 58.8, and 37.8 % and 1, 5, and 9 years, respectively; p = 0.0097).


Hemodynamic assessment of portal flow direction is important before B-RTO, and care should be taken to manage thrombotic disorders in the perioperative period in patients with reversed portal flow after B-RTO. Another treatment option might be preferred for gastric varices in Child classes B and C patients with reversed portal flow instead of B-RTO, which may have a poor prognosis.


Balloon-occluded retrograde transvenous obliteration (B-RTO) Doppler ultrasound Gastric varices Portal hypertension 


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Copyright information

© Asian Pacific Association for the Study of the Liver 2012

Authors and Affiliations

  • Hidehiro Kamezaki
    • 1
  • Hitoshi Maruyama
    • 1
    Email author
  • Taro Shimada
    • 1
  • Masanori Takahashi
    • 1
  • Hidehiro Okugawa
    • 1
  • Osamu Yokosuka
    • 1
  1. 1.Department of Medicine and Clinical Oncology, Graduate School of MedicineChiba UniversityChibaJapan

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